March–April 2022

www.nutritionhealthreview.com March-April 2022 • Volume 139

Nutrition

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Health Review

T h e Co n s u m e r ’s M e d i ca l J o u r n a l Inside the Issue Nutrition and Health •

The Sunny Side Up of Eggs: Unscrambling the Truth About Their Nutritional Value

•

Five Power-packed Vegetables You Should Try

•

Know Your Nutrient—Collagen

•

The Need to Personalize the Approach to Nutrition

•

Superfood Spotlight—Garlic

•

Nutrition for Stress and Anxiety

•

Know Your Medicinal Plant— Lemon Balm

Body Basics •

Dietary Fat: The Good and the Bad

Healthy Activities •

Planting a Medicinal Herb Garden

•

Temperance Training: Fitness with a Purpose Recipes

egetus Foundation

•

Purslane Salad

•

Roasted Sunchokes

•

Kohlrabi Sautée

•

Jackfruit Taquitos

•

Chayote Stir Fry

©

EDITORIAL MESSAGE

March-April 2022 • Vol. 139

Dear Readers: Welcome to the March-April 2022 issue of Nutrition Health Review (NHR). We start this issue with an article that unscrambles the truth about the nutritional value of eggs, followed by a scientific discussion on dietary fats, good and bad. In the next article, we review five nutrient-dense vegetables you may never have heard of and include a recipe for each vegetable. Following this, we present our Know Your Nutrient star: collagen.

Next, we include an article on one of my favorite topics: gardening—If you’re like me and love to garden, you’ll appreciate learning more about herbs you can plant in the backyard that not only add beauty and attract pollinators, but may offer some health benefits as well.

We also provide an article that reviews some important nutrients your body needs to manage stress. And don’t miss this month’s Superfood Spotlight on garlic, plus much more!

As always, we hope you enjoy this edition of NHR as much as we did pulling it together for you. Best wishes for a healthy, happy 2022.

With warm regards, Elizabeth A. Klumpp Executive Editor NHR

NHR EDITORIAL STAFF Elizabeth Klumpp Executive Editor Julia Eckert Associate Editor Austin Vitelli Associate Editor Sarabeth Henne Assistant Editor Amanda Tolvaisa Assistant Editor Gannon Vitelli Assistant Editor BUSINESS STAFF Robert Dougherty President/Group Publisher Joseph Morris Senior Vice President Giselle Geddes, MD Chief Medical Officer Ali Kinnie Publisher, Director of Media Relations E. Patrick Scullin Director of Finance Emily Scullin Associate Director of Business Development Nutrition Health Review: The Consumer’s Medical Journal© ISSN 0164-7202 is published 6 times a year

by Matrix Medical Communications © 2022 all rights reserved. Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Matrix Medical Communications, the Vegetus Foundation, the editorial staff, or any member of the editorial advisory board. Matrix Medical Communications and the Vegetus Foundation are not responsible for accuracy of dosages given in the articles printed herein.

The appearance of advertisements in this journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Matrix Medical Communications and the Vegetus Foundation disclaim responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements.

Subscriptions and address changes: Subscriptions are $18.00 annually. International print subscriptions are not available. To subscribe, please visit https://tinyurl.com/ y8q72dw5 and complete the online subscription form, or complete and return the subscription form found in the magazine by faxing (when paying with credit card) or mailing (when paying by check made payable to Vegetus Foundation) to Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Toll-free 866.325.9907; Phone 484.266.0702; Fax 484.266.0726. Address changes should be mailed to above or emailed to info@matrixmedcom.com Editorial queries: Elizabeth Klumpp, Vice President/ Editorial Director, Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380; Phone: (484) 266-0702; E-mail: eklumpp@matrixmedcom.com Please visit NHR’s website:

www.NutritionHealthReview.com

egutus Foundation

2

Nutrition Health Review • March–April 2022 • Volume 139

TABLE OF CONTENTS

VETERANS CORNER VA shares implementation plan and locations of PAWS Act pilot program. The Department of

March-April 2022

Veterans Affairs published a Federal Register Notice,

Volume 139

program required by the Puppies Assisting Wounded

March 30, on its plan for implementing the pilot Servicemembers for Veterans Therapy Act. Read more: https://www.va.gov/opa/pressrel/pressrelease.

Nutrition and Health

cfm?id=5779

•

to Veterans and families. The Department of

•

The Sunny Side Up of Eggs: Unscrambling the Truth About Their Nutritional Value .........................................4 Know Your Medicinal Plant— Lemon Balm ................................................ 10

VA promotes greater access to voter information Veterans Affairs unveiled a series of measures, March 24, promoting greater access to voter information for Veterans and their families as part of the department’s proposed designation as a voter registration agency under the National Voter

Five Power-packed Vegetables You Should Try .............................................11

Registration Act. Read more: https://www.va.gov/

•

Know Your Nutrient—Collagen ...............17

transitional housing facilities. The Department

•

Nutrition for Stress and Anxiety............22

totaling approximately $64.7 million to community

•

The Need to Personalize the Approach to Nutrition .............................24

organizations under VA’s Grant and Per Diem program

Superfood Spotlight—Garlic ..................29

va.gov/opa/pressrel/pressrelease.cfm?id=5775

•

•

Body Basics •

Dietary Fat: The Good and the Bad .....11

opa/pressrel/pressrelease.cfm?id=5776 VA to award millions in grants to improve of Veterans Affairs is awarding 36 capital grants

to improve the quality of housing options for Veterans experiencing homelessness. Read more: https://www.

OBESITY MEDICAL ASSOCIATION Is BMI Outdated? An Analysis of Body Mass Index and Health.Does your healthcare provider

Healthy Activities

talk to you about your body mass index (BMI) and do

•

Planting a Medicinal Herb Garden ..... 19

an oversimplification of a healthy weight we discuss

•

Temperance Training: Fitness with a Purpose ............................26

Recipes

you know what it really means? Widely criticized as if BMI is a misleading metric. Read more: https:// obesitymedicine.org/is-bmi-body-mass-index-anoutdated-metric/

ACADEMY OF NUTRITION AND DIETETICS (AND)

•

Purslane Salad ........................................... 12

•

Roasted Sunchokes .................................. 13

•

Kohlrabi Sautée ......................................... 14

a tasty dinner on the table easily and quickly. The

•

Jackfruit Taquitos ...................................... 15

the dinnertime dilemma. Read more: https://www.

•

Chayote Stir Fry .......................................... 16

Delicious Family Dinners for Weeknights. There are several simple steps that can help families get AND offers a few easy and effective approaches to eatright.org/food/planning-and-prep/cooking-tipsand-trends/delicious-family-dinners-for-weeknights NHR

Nutrition Health Review • March–April 2022 • Volume 139

3

Nutrition and Health

The Sunny Side Up of EGGS Unscrambling the Truth About Their Nutritional Value

W

hile eggs are a breakfast

recommendation in 2015. Since then,

egg contains 186 milligrams (mg)

staple, the debate around

egg consumption has steadily risen.5

of cholesterol. Health experts

their health benefits and

Now, more than 50 years of research

suggest limiting intake of dietary

risks continues to unfold. Nutrition

shows that moderate egg intake is

cholesterol—ideally keeping it under

researchers and scientists have long

not associated with increased health

300mg a day.9 This doesn’t mean

questioned their nutritional value. In

risk. On top of that, experts say

you have to pump the brakes on

fact, the American Heart Association

this small-but-mighty food is worth

eating eggs though. While some

(AHA) once recommended that

incorporating into our diet.6

studies suggest a link between egg consumption and CVD, it could be

people eat no more than three whole eggs a week.1 Now, the organization has given the public the greenlight to eat up to one Researchers have

due to several other factors.10 Other

The egg’s main claim to fame

breakfast foods, such as bacon,

is its high nutrient content. This is

sausage, ham, and cheese, may

especially true regarding protein—

pose more risk than eggs for CVD.

come to understand that the former

eggs pack a mighty punch. One large

This apparent relationship could

recommendation was based upon

egg—the standard in the United

also be attributed to the ways that

misinterpreted data. Still, the debate

States—contains 6 to 8 grams of

eggs are prepared. For example,

remains. Here’s is what we do know

protein.

about eggs.

cup of cottage cheese (12g protein)

play more of a role in the increased

or two tbss of peanut butter (7g

risk of heart disease than eggs

protein).8 While the protein found in

by themselves. When looking at

egg per day.

2,3

HISTORY

Of the vast variety of foods

2,7

Compare this to a half

eggs fried in oil or butter could

eggs is distributed equally between

studies that examine the relationship

we eat, only eggs have been

the egg white and egg yolk, other

between egg consumption and

specifically singled out for restriction

nutrients are mostly concentrated

heart disease, it is important to keep

in a public health effort to reduce

in the yolk.6 Eggs also are a good

the golden rule of research in mind:

cardiovascular disease (CVD) risk.1

source of lipids, vitamins, and

correlation does not always equal

This is due to the yolks’ high levels of

minerals. In fact, the yolk contains

causation.

cholesterol. When the AHA issued

all vitamins except for vitamin C, as

their egg advice in 1968, Americans

well as all essential trace elements,

listened. The egg industry saw a

including copper, iron, magnesium,

substantial drop in consumption

manganese, selenium, and zinc.6

4

4

NUTRITIONAL VALUE

over the subsequent years. The AHA

Egg yolks are notoriously high

updated their advice to their current

in cholesterol. A typical large raw

Nutrition Health Review • March–April 2022 • Volume 139

BENEFITS OF EGGS

Moderate calorie source, high satiety. Depending on its size, one egg provides 50 to 90 calories.11 This is a moderate number of calories

when compared to other foods of a

the arteries and back toward the

storing, preparing, and serving

similar size. The real value, however,

liver where LDL is broken down. This

eggs.24

is its high satiety effect, or the

is one reason why eggs have been

Buying. For consumers, egg

absence of hunger after eating. Egg

found to have little to no effect

safety starts at the grocery store.

protein, which prompts significant

on heart disease risk.18-20 Notably,

When browsing the dairy section,

changes in satiety hormones, has

HDL cholesterol doesn’t completely

make sure to buy eggs that are

significant effect on hunger.1,12,13 For

eliminate LDL cholesterol. Only

refrigerated at a temperature of 40°

example, several studies have shown

one-third to one-fourth of blood

F or below. Grocery stores often have

reduced caloric intake after an egg

cholesterol is carried away by HDL.17

a thermometer inside refrigerated

12

breakfast compared to a bagel

Good for eye health. Eggs

areas. Do not buy eggs that are

breakfast.12 This may promote weight

are highly bioavailable sources

loss in those seeking to reduce their

of lutein and zeaxanthin (L/Z)—

weight. People who eat eggs feel

antioxidants that can reduce the

eggs can affect both their quality

fuller and are less likely to eat more

risk of certain eye diseases—which

and safety. If eggs crack on the

during or immediately after the meal.

means that these nutrients in egg

way home from the store, break

cracked.

Storing. Raw. Proper storage of

form are better absorbed by the

them into a clean container, cover

accessibility. Eggs are one of

body than from alternate sources.

tightly, keep refrigerated, and use

the most widely available and

L/Z accumulate in the retina of

within two days.24 Do not put broken

economical sources of animal

the eye and help form the retinal

eggshells back in the carton.25 Due

Low economic cost, better

protein worldwide. About 12 percent

macular pigment (MP), which can

to how easily eggs can become

of Americans are food insecure,

help improve visual performance

contaminated, the cartons can

which has been linked to a multitude

and protect the eyes against the

quickly become a reservoir for

of negative health outcomes. Across

damaging effects of light.21 Notably,

bacteria. Make sure to store eggs in

the globe, this figure increases to

L/Z can prevent age-related macular

the coolest part of the refrigerator.

30 percent, a value that has been

degeneration (AMD), a leading

Placing them inside the doors’

steadily increasing. Eggs are cost

cause of blindness in the developed

shelves makes them vulnerable to

efficient. When comparing the

world that is expected to increase in

varying temperatures and can also

relationship between foods based

the coming years.

put them at a higher risk of falling

1

14

21

on calories and unit cost, the energy cost of eggs is less than that of other animal-protein foods, such as meat,

and cracking.

FOOD SAFETY AND STORING EGGS

Fresh eggs, even those with clean

Eggs can be frozen for up to one month, but they should never

poultry, and fish.15 This is why egg

uncracked shells, may contain

be frozen in their shells.24 Instead,

consumption may be a valid dietary

Salmonella, which can cause

beat yolks and whites together;

staple for food-insecure families,

foodborne illness. A contaminated

egg whites can also be frozen by

especially those challenged by

hen can transmit Salmonella

themselves. If storing hard-boiled

limited nutritional intake.

2

inside the egg if the shell has not

eggs, be sure to consume them within

Improves “good” cholesterol.

completely formed, but the bacteria

one week. The same rule applies if

There are two types of cholesterol:

can also penetrate eggshells, which

they are still in the shell or peeled.

high-density lipoprotein (HDL)—or

have tiny open pores.4 The United

“good” cholesterol—and low-

Stats Food and Drug Administration

equipment, and work surfaces with

density lipoprotein (LDL)—or “bad”

(FDA) has implemented many

hot, soapy water before and after

cholesterol. LDL contributes to fatty

safeguards to prevent contamination

contact with raw eggs or raw egg-

buildups in arteries, which narrows

during farming, shipping, and storing

containing foods.25 To ensure eggs

them, increasing the risk for heart

of eggs, but the consumer also has a

have even heat distribution, cook

attack, stroke, and peripheral artery

role in protecting themselves against

them slowly over gentle heat. Eggs

disease. HDL, on the other hand,

egg-related illness. The FDA provides

should be cooked until both the yolk

carries “bad cholesterol” away from

the following safety tips on buying,

and the white are firm. Foods that

16

17

Preparing. Wash hands, utensils,

Nutrition Health Review • March–April 2022 • Volume 139

5

contain eggs, such as casseroles, quiches, soufflés, and baked goods, should be cooked until the internal

3.

temperature reaches at least 160º F.4,26 If a recipe calls for raw or undercooked eggs, such as Caesar salad dressing, homemade ice cream,

4.

or homemade mayonnaise, only use eggs that have been treated to destroy Salmonella by pasteurization

5.

or another approved method.

Serving. Serve cooked eggs and egg-containing foods immediately after cooking. If you choose to refrigerate these products, they

6.

should be thoroughly reheated to at least 165° F before serving. Eggs should never be out of the refrigerator

7.

for more than 2 hours or for more than 1 hour when temperatures are above 90° F.25 8.

BOTTOM LINE

Whether they’re fried, poached, scrambled, or boiled, eggs can be a tasty, versatile protein choice. They are rich in vitamins and nutrients

9.

and have numerous benefits for your health. Like all foods, however, moderation is key. People with a high risk for CVD should be mindful of

10.

their egg consumption and search for other plant-based protein options.

11.

Make sure you buy, transport, and store your eggs properly.

EDITOR’S NOTE

12.

Consult with a licensed nutritionist/ dietitian or qualified healthcare professional to discuss what, if any, dietary modifications, including the

13.

addition of eggs, are right for you.

REFERENCES 1.

2.

6

McNamara DJ. The fifty-year rehabilitation of the egg. Nutrients. 2015;7(10):8716-8722.

AHA taff. 16 Aug 2018. Are eggs good for you or not? American Heart Association

14.

website. https://www.heart.org/en/ news/2018/08/15/are-eggs-good-for-youor-not. Accessed 2 Mar 2022.

Dehghan M, Mente A, Rangarajan S, et al.

Association of egg intake with blood lipids, cardiovascular disease, and mortality in 177,000 people in 50 countries. Am J Clin Nutr. 2020;111(4):795-803.

Eggs. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard. edu/nutritionsource/food-features/eggs/.

Accessed 2 Mar 2022.

Shahbandeh M. Per capita consumption of eggs in the United States from 2000 to 2021. Updated 21 Jan 2022. Statistica website. https://www.statista.com/ statistics/183678/per-capita-consumptionof-eggs-in-the-us-since-2000/. Accessed 2 Mar 2022.

Réhault-Godbert S, Guyot N, Nys Y. The golden egg: Nutritional Value, Bioactivities, and Emerging Benefits for Human Health.

Nutrients. 2019;11(3):684. Published 2022 Mar 2019.

USDA. Eggs, Grade A, large, egg whole.

Updated 6 Dec 2019. United States Department of Agriculture – FoodData Central website. https://fdc.nal.usda. gov/fdc-app.html#/food-details/748967/ nutrients. Accessed 2 Mar 2022.

Manaker L. The 8 best high-protein foods, according to a dietitian. 28 Dec 2021.

EatingWell website. https://www.eatingwell. com/article/7938628/high-protein-foodslist-according-to-a-dietitian/. Accessed 2 Mar 2022.

Lopez-Jimenez F. Eggs: are they good or bad for my cholesterol? 21 Jan 2022. Mayo Clinic website. https://www.mayoclinic. org/diseases-conditions/high-bloodcholesterol/expert-answers/cholesterol/faq20058468. Accessed 2 Mar 2022.

Soliman GA. Dietary cholesterol and the lack of evidence in cardiovascular disease.

Nutrients. 2018;10(6):780.

Gordon B. Understanding egg labels.

Updated Feb 2020. EatRight website. https://www.eatright.org/food/nutrition/ nutrition-facts-and-food-labels/ understanding-egg-labels. Accessed 2 Mar 2022.

Keogh J, Clifton P. Energy intake and satiety responses of eggs for breakfast in overweight and obese adults: a crossover study. Int J Environ Res Public Health.

2020;17(15):5583.

Vander Wal JS, Gupta A, Khosla P, Dhurandhar NV. Egg breakfast enhances weight loss. Int J Obes (Lond.). 2008: 1545–1551.

Food and Agriculture Organization, International Fund for Agricultural Development, United Nations Children’s Fund. The state of food security and nutrition in the world 2021. https://www. fao.org/state-of-food-security-nutrition.

Nutrition Health Review • March–April 2022 • Volume 139

Accessed 7 Mar 2022.

15. Walker S, Baum JI. Eggs as an affordable source of nutrients for adults and children living in food-insecure environments. Nutr Rev. 2022;80(2):178-186.

16. Australian Eggs Limited website. Eggs and cholesterol. https://www.australianeggs.org. au/nutrition/cholesterol. Accessed 7 Mar 2022.

17. AHA staff. HDL (good), LDL (bad) cholesterol and triglycerides. Updated Nov 6, 2020.

American Heart Association website. https://www.heart.org/en/health-topics/ cholesterol/hdl-good-ldl-bad-cholesteroland-triglycerides. Accessed 7 Mar 2022.

18. Shortsleeve C. Are eggs healthy? here’s what experts say. Updated 20 Mar 2019.

TIME Magazine website. https://time. com/5469246/eggs-nutrition-healthy/.

Accessed 2 Mar 2022.

19. Cimons M. Eating too many eggs can still be risky, but most people don’t have to give them up entirely, experts say. 31 Jul 2021.

Washington Post website. https://www. washingtonpost.com/health/eggs-howmany-safe-eating-cholesterol/2021/07/30/ ff759696-ee31-11eb-81d2-ffae0f931b8f_ story.html. Accessed 2 Mar 2022.

20. Fuller NR, Sainsbury A, Caterson ID, et al.

Effect of a high-egg diet on cardiometabolic risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) Studyrandomized weight-loss and follow-up phase. Am J Clin Nutr. 2018;107(6):921-931.

21. Eisenhauer B, Natoli S, Liew G, Flood VM. Lutein and zeaxanthin-food sources, bioavailability and dietary variety in agerelated macular degeneration protection.

Nutrients. 2017;9(2):120.

22. The Food and Drug Administration website.

Egg safety final rule. Updated 6 Apr 2020. https://www.fda.gov/food/eggs-guidancedocuments-regulatory-information/eggsafety-final-rule. Accessed 7 Mar 2022.

23. United States Food and Drug Administration website. What you need to know about egg safety. Updated 17 Feb 2022. https://www. fda.gov/food/buy-store-serve-safe-food/ what-you-need-know-about-egg-safety.

Accessed 7 Mar 2022.

24. El-Begearmi M. Bulletin #2257, food safety facts: facts about eggs. University of Maine Cooperative Extension Publications website. https://extension.umaine.edu/ publications/2257e/. Accessed 7 Mar 2022.

25. Tufts University website. Eggs with cracked shells: still safe to eat? 7 Sep 2019. https:// www.nutritionletter.tufts.edu/generalnutrition/eggs-with-cracked-shells-still-safeto-eat/. Accessed 7 Mar 2022.

26. U.S. Poultry and Egg Export Council website. Safety and handling of eggs. https://www.usapeec.org/poultryandeggs/ safetyandhandling/. Accessed 7 Mar 2022.

NHR

Body Basics

Dietary Fat The Good and the Bad Conversely, mono- and

salts envelop the aforementioned fat

polyunsaturated fats

components to form micelles, which

are liquid at room

are able to pass through the watery

temperature and lower

mucous layer coating the absorptive lining of the digestive tract.5 The free

the LDL-C level in the

by Aliza Becker, BA, MPS

fatty acids and monoglycerides are

body.4

then subsequently released from

D

ietary fat provides the body with fatty acids that influence the metabolism, function, and

the micelles and enter the cells of

HOW THE BODY PROCESSES FAT Fat digestion begins in the mouth,

the digestive tract lining, where

where the enzyme lingual lipase

they reassemble into triacylglycerols

responsiveness of cells and tissues

primes triacylglycerols (triglycerides)

that combine with cholesterol and

to hormonal and other signals.1

and other lipid compounds for

phospholipids as well as a protein

However, not all dietary fats are

digestion. All fats are consumed in

carrier to become lipoproteins.5 These

equal. First, although all fats include

the diet as triacylglycerols, which

lipoproteins enter the lymphatic

a chain of carbon atoms bonded to

are composed of three fatty acids

system and are released into the

each other and to hydrogen atoms,

of varying lengths and compositions

bloodstream via the jugular vein in

the length and shape of the carbon

esterified to a glycerol molecule. In

the neck, which transports them to

chain and the number of hydrogen

the stomach, gastric lipase begins

various locations for use or storage in

atoms vary among them. A longer

breaking the primed triacylglycerols

adipose tissue.5

carbon chain length results in a

into diglycerides and fatty acids;

higher melting point and a fat that

however, the majority of fat digestion

is more solid at room temperature,

ultimately occurs in the intestines.5

and a carbon chain that is filled to

As the stomach contents enter

type of fat, is a byproduct of the

capacity with hydrogen atoms (as

the small intestine, persisting fat

hydrogenation process used to

opposed to containing ≥1 double

compounds are combined with

convert liquid vegetable oil into a

bonds between carbon atoms)

watery fluids from the body using

solid fat at room temperature. With

results in a fat that is “saturated.” As

bile as an emulsifier to increase their

no known health benefits, its use has

such, saturated and trans fats are

surface area and make them more

been banned in the United States

generally solid at room temperature,

accessible to the digestive enzymes.

since January 2020.6 Some amount

raise the body’s low-density

Pancreatic lipase then breaks down

of trans fat occurs naturally in food

lipoprotein cholesterol (LDL-C) level,

these remaining fats into free fatty

products from ruminant animals, such

and are considered unhealthy.4

acids and monoglycerides, and bile

as milk, butter, cheese, and meat

5

2

3

SOURCES AND INTAKE GUIDELINES Trans fat, considered the “worst”

5

Nutrition Health Review • March–April 2022 • Volume 139

7

WHAT’S KETO?

When the body requires energy, it turns first to carbohydrates (which provide glucose) and then to fat if the carbohydrate supply has been exhausted. As such, availability of an adequate amount of carbohydrates means that any fat consumed in the diet will instead be stored in the body. In response, the ketogenic diet, although first used to treat epilepsy in 1921, has experienced a resurgence in popularity in recent years.30 The diet plan for the keto diet stipulates the consumption of high fat and very low carbohydrate concentrations alongside a moderate amount of protein to force the body to ultimately enter a state of ketogenesis, where it relies on ketone bodies as an alternate source of energy due to the unavailability to glucose.30 This diet may have positive effects on health, such as transient reductions in blood pressure, triglycerides, and glycosylated hemoglobin values, together with weight loss and increases in highdensity lipoprotein cholesterol levels within the first 6 to 12 months; however, concomitant increases in LDL-C and very-low-density lipoprotein cholesterol may increase the cardiovascular risks.31 The diet may also be unsustainable for some due to the dietary restrictions required to sustain ketosis.31 products.6 Food sources of saturated

based on a 2,000-calorie diet are 78

is that saturated fats can cause

fat include red meat, whole milk,

grams for adults (including pregnant

cardiovascular disease (CVD); this

cheese, coconut oil, and commercially

women) and children four years of age

was first voiced in the 1950s by

prepared baked goods.2

or older, and 39 grams for children 1

physiologist Ancel Keys, whose

to 3 years of age. For saturated fat,

“diet–heart hypothesis” subsequently

fats are found in plant oils, nuts,

these numbers are 20 grams and 10

gained widespread acceptance in the

and seeds, although certain foods

grams, respectively. The most recent

1970s and ‘80s with the publication

are better sources of one or the

US Dietary Guidelines for Americans

of several large international studies

other. Olive, peanut, and canola oils;

recommends limiting saturated fat

supporting this association.11 Newer

almonds, hazelnuts, and pecans; and

intake to 10 percent of total calories

research suggests, however, that

pumpkin and sesame seeds offer high

consumed. The National Cholesterol

the strength of this relationship

concentrations of monounsaturated

Education Program has suggested

is uncertain.11 For example, nine

fat. Good sources of polyunsaturated

saturated fats should comprise less

meta-analyses of observational

fat include sunflower, corn, soybean,

than seven percent of total calories,

data conducted between the

and flaxseed oils; walnuts; and flax

whereas poly- and monounsaturated

years 2010 and 2021 found no

seeds.7 Additionally, avocado is a

fats should comprise no more than

significant associations between

good source of monounsaturated

10 percent and 20 percent of total

the consumption of saturated fat

fat, while fish is a good source of

calories consumed, respectively.10

and coronary heart disease (CHD).11

Both mono- and polyunsaturated

8

8

9

In addition, a systematic review

polyunsaturated fat.

7

The United States (US) Food and Drug Administration (FDA)’s daily reference values for total fat intake

8

FAT CONSUMPTION AND HEALTH Perhaps the most well-known consequence of fat consumption

Nutrition Health Review • March–April 2022 • Volume 139

published in 2020 by the Cochrane group, a British international charitable organization formed to

organize medical research findings,

gain. However, although the intake

tissue inflammation.28 Finally, the

reported that a reduction in dietary

of saturated fat should be limited as

percentage of overactive T-cells was

saturated fats reduced CVD events

a general rule, certain saturated fats

increased in mice fed a Western-style

but had no effect on total mortality,

may be worse offenders than others.

high-fat diet for nine weeks, which

CVD mortality, CHD mortality, fatal

Following food consumption, long-

is a characteristic of autoimmune

heart attacks, non-fatal heart

chain saturated fats like palmitate

disease.29

attacks, or CHD events. Moreover,

and stearate (found in various animal

simply reducing one’s saturated

products) are more likely to be stored

12

fat intake does not automatically

in adipose tissue, while medium-chain

lead to improved cardiovascular

saturated fats like lauric acid (found

health; for example, a large

in coconuts) and monounsaturated

Danish prospective cohort study

fats may be more likely to be burned

concluded that, when saturated fat

for energy.19

13

was replaced with high–glycemic

Greater daily total fat intake

index (GI) carbohydrates, the risk of

levels, especially over 65 grams,

myocardial infarction increased by 33

may significantly increase the risk

percent. Replacing saturated fats

of ischemic stroke.20 Conversely,

instead with mono- and especially

some research suggests that

polyunsaturated fats, however, can

a greater intake of saturated

reduce LDL-C and total cholesterol

fats can reduce risk of stroke.21,22

levels, increase the high-density

Greater intake of saturated and

lipoprotein (good) cholesterol level,

trans fats may increase the risk

and reduce triglyceride levels.

for cognitive disorders, such as

14

15

Obesity is another major

Alzheimer’s disease,23,24 and inverse

adverse health result of excessive

associations between a high intake

fat consumption. Although some

of monounsaturated fat and a high

amount of dietary fats needs to

ratio of polyunsaturated to saturated

be consumed to obtain the fatty

fat intake and cognitive decline have

acids crucial for body functions—

been reported.24

including the essential fatty acids

A variety of studies suggest that

omega-3 and omega-6, which can

saturated fat can impact immune

only be obtained through food16—an

system function. In macaques,

overabundance of triacylglycerols

a diet high in saturated fat and

results in their deposition in adipose

cholesterol led to significantly

tissue through removal from

more rapid progression of

lipoproteins, breakdown into fatty

immunodeficiency virus disease.25

acids and glycerol, and intracellular

Individuals with asymptomatic

reassembly.5 Similarly, the intake of

severe acute respiratory syndrome

too many carbohydrates leads to an

coronavirus 2 infection reported a

overabundance of glycogen in the

lower intake of saturated fat than

muscles, which is returned to the liver,

symptomatic individuals.26 A high-

converted into triacylglycerols, and

fat diet may also be a risk factor

then stored as fat. Moreover, dietary

for the development of influenza

fat has a weaker effect on satiation,17

A virus–associated cardiovascular

leading to a greater risk of passive

damage.27 Mouse research has

overconsumption and a greater

determined that saturated fat may

energy density than carbohydrates or

stimulate macrophages to secrete

protein do,18 which can result weight

interleukin-1β, a driver of diet-induced

5

SOURCES

1.

Calder PC. Functional roles of fatty acids and their effects on human health. J Parenter Enteral Nutr. 2015;39(1 Suppl): 18S–32S. 2. Harvard Health Publishing. Harvard Medical School. The truth about fats: the good, the bad, and the in-between. https://www. health.harvard.edu/staying-healthy/thetruth-about-fats-bad-and-good. Accessed March 11, 2022.

3. How lipids work. In: University of Hawai’i at Mānoa Food Science and Human Nutrition Program. Human Nutrition [Depreciated].

Honolulu, Hawai’i: University of Hawai’i at Mānoa. http://pressbooks-dev.oer.hawaii. edu/humannutrition/chapter/how-lipidswork/. Accessed March 13, 2022.

4. Bhandari P, Sapra A. Low fat diet. [Updated 2022 Feb 10]. In: StatPearls [Internet].

Treasure Island, FL: StatPearls Publishing; 2022.

5. Digestion and absorption of lipids. In: University of Hawai’i at Mānoa Food Science and Human Nutrition Program.

Human Nutrition [Depreciated]. Honolulu, Hawai’i: University of Hawai’i at Mānoa. http://pressbooks-dev.oer.hawaii.edu/ humannutrition/chapter/digestion-andabsorption-of-lipids/. Accessed March 13, 2022.

6. United States Food and Drug Administration. Trans fat. https://www.fda. gov/food/food-additives-petitions/transfat. Accessed March 14, 2022.

7. Harvard T.H. Chan School of Public Health.

Types of fat. https://www.hsph.harvard.edu/ nutritionsource/what-should-you-eat/fatsand-cholesterol/types-of-fat/. Accessed March 13, 2022.

8. United States Food and Drug Administration. Frequently asked questions for industry on nutrition facts labeling requirements. https://www.fda.gov/ media/99059/download. Accessed March 13, 2022.

9. United States Department of Agriculture.

Dietary Guidelines for Americans 2020– 2025. https://www.dietaryguidelines. gov/sites/default/files/2021-03/Dietary_ Guidelines_for_Americans-2020-2025.pdf.

Accessed March 15, 2022.

10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection,

Nutrition Health Review • March–April 2022 • Volume 139

9

11.

12.

13.

14.

15.

16.

17.

Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–2497.

Astrup A, Teicholz N, Magkos F, et al.

Dietary saturated fats and health: are the U.S. guidelines evidence-based? Nutrients.

2021;13(10):3305.

Hooper L, Martin N, Jimoh OF, et al.

Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;5(5):CD011737.

Siri-Tarino PW, Chiu S, Bergeron N, Krauss RM. Saturated fats versus polyunsaturated fats versus carbohydrates for cardiovascular disease prevention and treatment. Annu Rev Nutr. 2015;35:517–543.

Jakobsen MU, Dethlefsen C, Joensen AM, et al. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr.

2010;91(6):1764–1768.

Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins. a meta-analysis of 27 trials. Arterioscler Thromb. 1992;12(8):911–919.

Nonessential and essential fatty acids.

In: University of Hawai’i at Mānoa Food Science and Human Nutrition Program.

Human Nutrition [Depreciated]. Honolulu, Hawai’i: University of Hawai’i at Mānoa. http://pressbooks-dev.oer.hawaii.edu/ humannutrition/chapter/nonessential-andessential-fatty-acids/. Accessed March 13, 2022.

Blundell JE, MacDiarmid JI. Fat as a risk

18.

19.

20.

21.

22.

23.

24.

25.

factor for overconsumption: satiation, satiety, and patterns of eating. J Am Diet Assoc.

1997;97(7 Suppl):S63–S69.

Rolls BJ. The role of energy density in the overconsumption of fat. J Nutr. 2000;130(2S Suppl):268S–271S. DiNicolantonio JJ. Good fats versus bad fats: a comparison of fatty acids in the promotion of insulin resistance, inflammation, and obesity. Mo Med. 2017;114(4):303–307.

Boden-Albala B, Elkind MSV, White H, et al. Dietary total fat intake and ischemic stroke risk: the Northern Manhattan Study.

Neuroepidemiology. 2009;32(4):296–301.

Kang Z-Q, Yang Y, Xiao B. Dietary saturated fat intake and risk of stroke: systematic review and dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis. 2020;30(2):179–189.

Cheng P, Wang J, Shao W, et al. Can dietary saturated fat be beneficial in prevention of stroke risk? a meta-analysis. Neurol Sci. 2016;37(7):1089–1098.

Barnard ND, Bunner AE, Agarwal U. Saturated and trans fats and dementia: a systematic review. Neurobiol Aging. 2014;35 Suppl 2:S65–S73.

Morris MC, Evans DA, Bienias JL, et al.

Dietary fat intake and 6-year cognitive change in an older biracial community population. Neurology. 2004;62(9):1573–1579.

Mansfield KG, Carville A, Wachtman L. A diet high in saturated fat and cholesterol accelerates simian immunodeficiency virus disease progression. J Infect Dis. 2007;196(8):1202–1210.

Know Your Medicinal Plant—Lemon Balm* Scientific name: Melissa officinalis Appearance: A member of the mint family, lemon balm is an erect herbaceous perineal that grows 1 to 3 feet in height with toothed, broadly oval to diamond-shaped leaves that are wrinkled and scalloped along the edges. When crushed, the leaves have a distinct lemon scent. The quarterinch flowers may be pale yellow, pink, or white and bloom in late summer.

Habitat: Native to southern Europe; now grown extensively throughout Europe; widely naturalized in North America, mostly in the northeastern United States and Canadian provinces Key constituents: Volatile oils—citral, citronellal; flavonoids—melissiosides A–C; polyphenols; tannins; triterpenes

10

Properties: Relieves stress and anxiety; aids in alertness, and memory; relieves cold sores; soothes skin abrasions and insect bites; antithyroid properties Parts used: Aerial parts—leaves Practical preparations and uses: Raw form—(ingested) thought to increase calmness, memory, and alertness in adults under mental stress; tincture form—drink with water for anxiety and mild depression; essential oil—massage across painful shingles gently; infusion—drink to soothe headaches; lotion—make an infusion to soothe cold sores and apply several times daily; juice—apply to cuts and scrapes; ointment—apply to insect stings.

Nutrition Health Review • March–April 2022 • Volume 139

26. Ponzo V, Pellegrini M, D’Eusebio C, et al.

Mediterranean diet and SARS-COV-2 infection: is there any association? a proofof-concept study. Nutrients. 2021;13(5):1721.

27. Siegers JY, Novakovic B, Hulme KD, et al. A high-fat diet increases influenza A virusassociated cardiovascular damage. J Infect Dis. 2020;222(5):820–831.

28. Robblee MM, Kim CC, Abate JP, et al.

Saturated fatty acids engage an IRE1αdependent pathway to activate the NLRP3 inflammasome in myeloid cells. Cell Rep. 2016;14(11):2611–2623.

29. Pollock AH, Tedla N, Hancock SE, et al.

Prolonged intake of dietary lipids alters membrane structure and T cell responses in LDLr-/- mice. J Immunol. 2016;196(10): 3993–4002.

30. Masood W, Annamaraju P, Uppaluri KR. Ketogenic diet. [Updated 2021 Nov 26]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.

31. Batch JT, Lamsal SP, Adkins M, et al.

Advantages and disadvantages of the ketogenic diet: a review article. Cureus.

2020;12(8):e9639.

ABOUT THE AUTHOR Ms. Becker is the managing editor of The Journal of Innovations in Cardiac Rhythm Management.

She also works as a freelance editor and as a teaching assistant for the George Washington University’s Master of Professional Studies in Publishing program. NHR

Sources: Chevallier A. Holy basil, tulsi (Hindi). Encyclopedia of Herbal Medicine.

New York, NY: DK Publishing; 2016:116; Johnson RL, Foster S, Dog TL, et al. Guide to Medicinal Herbs: The World’s Most Effective Healing Plants. Washington, DC: National Geographic Partners; 2010:35-37. *Consult with a qualified healthcare professional before attempting to self-treat ailments.

NHR

Nutrition and Health

Five Power-packed Vegetables You Should Try

These five vegetables may not be your usual go-tos, but they pack a powerful punch when it comes to nutrition…and they taste good too. So jazz up your menu and get adventurous in the kitchen!

Recipes Included!

colored stems and green paddleshaped leaves. Mid-to-late summer, it develops small bright yellow flowers.1 Though many people consider purslane a weed, its succulent leaves and stems are edible. In fact, these lemony, crunchy plants are not only

throughout the world. Purslane is

delicious, they are highly nutritious

considered a weed because it can

and are considered by some to be

oleracea), also known as little

grow just about anywhere, and you’ll

a superfood.2 Purslane contains the

hogweed or pursley, is a drought-

often finding it cropping up between

highest amount of vitamin A among

COMMON PURSLANE Common purslane (Portulaca

tolerant summer annual weed (perineal in tropical regions) that can grow under most adverse conditions and

cracks in the sidewalk

green leafy vegetables, and as

or concrete,

much as five times more omega-3

throughout your

fatty acids than spinach. Purslane

yard, and in your

has recently been identified as the

garden beds. It

richest vegetable source of alpha-

thrives in sunny, nutrient-

can reach six inches in

linolenic acid, an essential omega-3

rich, sandy soils.

height and two feet in

fatty acid. It also contains vitamin

Purslane is native to

width and grows into

C and B-complex vitamins (e.g.,

India and Persia, but is now commonly found

a dense circular mat of glossy succulent red-

riboflavin, niacin, and pyridoxine) and is an excellent source of dietary

Nutrition Health Review • March–April 2022 • Volume 139

11

minerals, including potassium,

do with Jerusalem nor are they

magnesium, calcium,

truly artichokes. Native to North

phosphorus, and iron.

2

Chances are purslane

VERY SIMPLE PURSLANE

America, sunchokes are the lumpy, brown-skinned tuber of a variety

is growing wild right

of sunflower. The tubers are a few

out in your backyard. It

inches long and resemble ginger

is generally considered

root, but, once peeled, have a

safe to pick and consume

similar texture to that of potatoes.4

wild purslane—just make

Unlike potatoes, sunchokes can

sure to rinse the plants

be eaten raw, but are generally

carefully to remove any

prepared in much the same manner

potential pesticides, and

as potatoes, parsnips, or turnips

don’t pick plants that

(e.g., boiled, grilled, mashed,

are growing right next to streets or

roasted, or fried).5 While the skins of

other places where it might come into

sunchokes are edible, they can be a

Serves 4

contact with pollutants. To ensure

bit stringy, so the skins are usually

INGREDIENTS

sure you’ve correctly identified a

removed prior to consuming.5

•

1/4 cup cider or white wine

purslane plant, break open one of its

SALAD

The sunchoke is a good

vinegar

stems. If a milky substance oozes out,

source of inulin, a prebiotic fiber

•

2 tsp sugar

it is not purslane—it is poisonous and

that stimulates the growth of

•

4 cups purslane, washed

should not be eaten.

bifidobacteria, a type of good

and patted dry • •

To prepare purslane, snip the plant

bacteria that reside in the human

Salt and freshly ground

at the main stem using scissors when

intestinal tract…but beware! Inulin

black pepper to taste

gathering. Fill the sink with cold

might make some people a little…

1 tbs finely chopped red

water and immerse the entire plant

um…gassy. The sunchoke is an

onion (optional)

in the water. Swish the plant around

excellent source of potassium,

in the water to remove any dirt. Snip

packing more potassium per 100

DIRECTIONS

off and remove thick stems. Dry the

grams than even bananas. The

1. In a large bowl, mix the

purslane with paper towels or spin it

sunchoke is also a good source

vinegar with sugar, whisking

in a lettuce spinner. It can be stored

of the B vitamins, thiamine in

until the sugar dissolves. Add

a plastic bag in the fridge for a few

particular, which play important

the purslane to the bowl and

days and even frozen for up to six

roles in nervous system and muscle

toss to coat. Season with

months (after blanching). Purslane

functioning, and carbohydrate

salt and pepper to taste and

leaves can be tossed raw into a salad

metabolism.6

toss again.

or cooked as a side dish. The stems 3

Sunchokes are easy to grow. They

and leaves are also mucilaginous

are perinneals in Zones 2 to 8, but

least 15 minutes and up to

(gelatinous/viscous), meaning they

can be grown as annuals in Zones

an hour. Sprinkle with red

can be used to thicken soups and

9 and 10 (though they won’t get as

onions and serve.

stews.

big). The tubers can be planted in

2. Cover and refrigerate for at

1

the spring and then harvested in NUTRITION INFORMATION Calories: 29; Protein: 1g;

SUNCHOKES Sunchokes

The plants get 6 to 12 feet tall,

Carbohydrates: 6g; Fat: 0g;

(Helianthus

Cholesterol: 0mg; Sodium: 73g;

tuberosus) are

Dietary fiber: 1g

also known

foot spread

as Jerusalem

underground,

artichokes, though they have nothing to

12

the fall after the first hard freeze.

Nutrition Health Review • March–April 2022 • Volume 139

and each plant has a two-

so they are best planted

ROASTED SUNCHOKES Serves 4 INGREDIENTS •

1 ¼ pounds small sunchokes, scrubbed and halved lengthwise

•

2 tbs olive oil, divided

•

½ tsp kosher salt, divided

•

¼ tsp freshly ground black pepper

•

2 to 4 cloves of garlic

•

4 rosemary sprigs

DIRECTIONS Preheat oven to 375°.

1. Combine sunchokes, 1 tbs olive oil, 1/4 tsp salt, and pepper in a large bowl; toss well to coat.

2. Heat 1 tbs oil in large skillet (cast iron is best) over mediumhigh heat 3. Arrange sunchokes, cut side down, in pan until they start to brown (about 5 minutes).

4. If using a cast iron skillet, arrange garlic and rosemary evenly over sunchokes. If using a regular skillet, transfer ingredients to a baking dish and arrange as described (but add a little additional oil to the dish to prevent sticking). Place cast iron skillet or baking dish in oven and roast at 375° for 40 minutes or until sunchokes are tender and deep golden.

5. Sprinkle with remaining 1/4 tsp salt.

NUTRITION INFORMATION (per 0.5 cups); Calories: 143; Fat: 6.9g; Protein: 2g; Carbohydrates: 20g; FIber: 2g; Iron: 4mg; Sodium: 246mg; Calcium: 32mg.

in a sunny area

into slaw or chopped into small

where it is ok for

matchsticks and tossed raw into

them to spread.

salad or into the wok for stir fry. Like

They will continue

a turnip or potato, it can be boiled,

to produce

grilled, mashed, or roasted. The

more and more

greens can be chopped and added

tubers each year,

raw to salad or cooked like you

which turn into

would spinach or collards.10

more sunchoke

Kohlrabi is an excellent source

plants, so be careful…they really can

of fiber and vitamin C. It is a good

take over an area. For those with

source of vitamin B6, potassium,

backyard gardens on the smaller

magnesium, manganese, folate, and

size, planting sunchokes in large

protein.11

containers might be the best

Kohlrabi is a cool

way to go.7,8

weather vegetable and is easy to grow. It can

KOHLRABI Kohlrabi

be planted

(Brassica

in early

oleracea), also

spring and

known as a

harvested in early

German turnip, is a

summer or planted

biennial plant thought

late summer and harvested

to be native to northern

in late fall. In regions with

Europe.9 The whole

mild winters, kohlrabi can

kohlrabi plant—except for the root—is edible and can be eaten raw or

be left in the ground and harvested throughout the winter. Kohlrabi has a large

cooked. It is a cruciferous plant,

root system, so it is not suitable for

like cabbage, broccoli, and kale,

container growing.12

and looks like a cross between a turnip and a head of cabbage. The

JACKFRUIT

pale green bulb is 3 or 4 inches

The jackfruit tree (Artocarpus

in diameter (about the size of an

heterophyllus) is native to tropical

orange) with a tall crown of pale

Asia, but is widely grown throughout

green stems and big leaves jutting

wetland tropics. It is known for its

from the top. Like other cruciferous

large fruit and durable

vegetables, it has a slightly sweet,

wood. The fruit of

slightly bitter/peppery flavor.10 When preparing Kohlrabi, the thick outer skin

the jackfruit tree is considered the largest tree-

should first be

born fruit in

removed. The

the world,

vegetable

reaching

is versatile.

upwards

Like cabbage,

of 2 feet in

it can be grated

length and 40

Nutrition Health Review • March–April 2022 • Volume 139

13

KOHLRABI SAUTÉE Serves 4 INGREDIENTS •

3 medium kohlrabies

•

1 tbs toasted sesame oil

•

2 cups shaved carrots

•

3 scallions, coarsely chopped

•

1 medium jalapeño chile, sliced (optional)

•

1 tbs minced garlic

•

1 tbs lime juice

•

2 tsp grated fresh ginger

•

1 tsp light brown sugar

•

1/8 tsp kosher salt

•

1/4 cup cilantro leaves

•

3 tbs coarsely chopped roasted unsalted peanuts

DIRECTION 1. Chop kohlrabi leaves. Peel kohlrabi bulbs, and cut in half; thinly slice into half moons.

2. Heat oil in a large skillet over high heat. Add kohlrabi bulbs, stirring often, about 5 minutes (or until they start to soften). Add kohlrabi leaves, carrots, scallions, and jalapeño to skillet; cook, stirring often, until leaves and bulbs are tender, about 4 to 5 minutes.

3. Add garlic, lime juice, ginger, brown sugar, and salt to skillet. Cook, stirring constantly about 1 minute. Remove from heat. Sprinkle with cilantro and peanuts NUTRITION INFORMATION (per 1.5 cups) Calories: 128; Fat: 7g; Protein: 4g; Carbohydrate 15g Fiber 6g; Sugars 6g; Added sugars 1g; Sodium 394mg; Calcium 6% DV; Potassium 12% DV

pounds in weight, sometimes even bigger.13 According to Guinness World Records, in 2016, the largest jackfruit was recorded at 22 inches long and 52 inches in circumference, with a weight of 94 pounds and 2.9 ounces.14 The oblong fruit has a yellow-green (unripe) to brownish (ripe) hard, bumpy rind that, when ripe, encloses several bright yellow fleshy pods, each of which houses a large seed. When unripe, the flesh of the jackfruit is white, and the pods and seeds are much smaller.13 The jackfruit can be consumed when it is unripe or ripe. The stringy texture and neutral flavor of the unripe fruit has made jackfruit a popular plant-based substitute for meat (though its protein content is minimal). Ripe jackfruit, on the other hand, has a very sweet taste similar to pineapple or mango, though still chewy and stringy.15 Jackfruit is a good source of fiber, potassium, and antioxidants, including vitamin C, B vitamins, calcium, and magnesium, as well as flavonoids and lignans, which are thought to have anti-inflammatory properties.15 Your local grocery store may or may not offer fresh jackfruit in its product department; but you will likely find fresh in-season jackfruit at Whole Foods or other similar specialty or gourmet grocery stores or the local Asian grocery store.

Other grocery store chains, such as Trader Joes, may not sell fresh jackfruit, but may offer it in canned form. If buying canned jackfruit, read the label to determine what type of liquid the fruit was packed in, as this will indicate whether the fruit was ripe or unripe when canned. If the label says the fruit

14

Nutrition Health Review • March–April 2022 • Volume 139

it is low in calories and simple carbohydrates, but high in

JACKFRUIT TAQUITOS Serves 8 INGREDIENTS • 1/2 tbs tomato paste • 1/2 tbs soy sauce • 1/2 tsp hot sauce • 1/2 tsp chipotle chili powder • 1/2 tsp smoked paprika • 1/2 tsp cumin • 1 tsp olive oil • 1 can jackfruit in brine, drained and shredded • 8 6-inch corn tortillas • 1/2 cup prepared guacamole DIRECTIONS 1. Preheat the oven to 400°F. 2. In a medium bowl, combine the tomato paste, soy sauce, hot sauce, chili powder, paprika, cumin, and olive oil.

Toss the shredded jackfruit in the sauce and set aside.

3. Warm corn tortillas in microwave oven (in ~ 10 sec increments) until pliable. Fill each tortilla with roughly 2 tbs of the jackfruit mixture, rolling to create large cigar-like shapes.

4. Place the taquitos on a baking sheet and bake for 10 minutes, or until golden brown and crispy. Serve with guacamole.

NUTRITION INFORMATION (per taquito) Calories: 120; Fat: 3.7g; Protein: 2.3g; Carbohydrate: 21g; Fiber: 5g; Cholesterol: 0mg; Sodium: 208mg; Calcium: 18mg; Sugars: 1.5g

nutrients, and it offers a number of nutritional benefits. Chayote squash is excellent source of fiber, vitamin B, vitamin C, potassium, amino acids, magnesium, calcium, and antioxidants. Most of these nutrients are found in the skin of the chayote squash, so consuming this was packed in brine or water,

vegetable with the skin on is ideal.16

this indicates it was canned in

Chayote squash can be consumed

its unripened state, and thus will

raw or cooked. It can be roasted,

be white in color and neutral in

grilled, fried, or boiled. It is suitable

taste. This form is ideal for use in

for both savory and sweet dishes.16

savory dishes or as a plant-based

If your normal grocery store

substitute for meat. If the fruit was

does not carry chayote squash,

packed in syrup, this indicates it was

you can likely find it at specialty

ripe when canned, and thus will be

or gourmet grocery stores, such

bright yellow in color and have a

as Whole Foods, or at your local

fruity, sweet taste. This form is ideal

farmers market. Keep in mind that

for use in sweet dishes, deserts,

chayote squash is a warm-tohot region vegetable, so if

or smoothies.

you live in colder regions of the country, local

CHAYOTE SQUASH

farmers markets may

Chayote squash

only carry them for

(Sechium edule) is a member of the gourd

limited periods of

family. Like other squash,

time; however, in

it is technically a fruit, but more commonly prepared as a vegetable. It is native to Mexico, and, while widely available in the Southwestern United States, it may

warmer climates, chayote squash may be available most of year, if not year-round.17 While chayote squash is easy to

be less commonly found in the other

grow in a home vegetable garden,

regions of the country.16

it requires at least four frost-free

Chayote squash is similar in

months from planting to harvest,

shape and size to a pear. Its thin

making it unsuitable for in-ground

skin is light to dark green in color,

planting in Zones 6 or lower in

with pale green flesh underneath.

the United States. For these lower

It has a neutral flavor, and all parts

zones, chayote squash can be

of the vegetable are edible (i.e.,

planted in containers, which could

skin, seeds, flesh), making chayote

then be moved inside before first

squash a versatile addition to any

frost, but it is a vigorous climber

meal.16

and will need a sturdy trellis, and

Chayote squash is considered a nutrient-dense food because

container plants tend to produce less fruit. Chayote squash can be

Nutrition Health Review • March–April 2022 • Volume 139

15

CHAYOTE STIR FRY Serves 8 INGREDIENTS •

4 chayote squash

•

3 tbs olive oil

•

4 shallots, thinly sliced

•

2 cloves garlic, minced

•

Kosher salt, to taste

•

Freshly ground black pepper, to

6.

7.

taste •

Chopped chives, parsley, and/or grated Parmesan cheese, garnish (optional)

8.

DIRECTIONS 1. Slice each squash in half lengthwise and scoop out the seeds. Place squash on a cutting board, cut-side down, and slice thinly.

2. Heat olive oil in a large skillet or wok over medium heat. Add the

9.

sliced shallots and cook for about 5 minutes, or until they are tender and beginning to brown. Add the garlic and continue to cook for 1 minute longer.

3. Add the sliced chayote squash to the skillet and continue to cook, tossing often, for 3 to 5 minutes, or until crisp-tender. Season with

10.

salt and pepper.

4. Serve the chayote squash with a garnish of fresh herbs and/or 11.

Parmesan cheese, if desired.

NUTRITION INFORMATION Calories: 86; Fat: 5g; Cholesterol: 11mg; Sodium: 77mg; Carbohydrate: 10g; Fiber: 5g; Sugars: 4g; Protein: 1g; Vitamin C: 13mg; Calcium: 29mg;

12.

Iron: 1mg; Potassium: 307mg 13.

14.

overwintered outdoors in Zones 7

2.

or higher. When sowing chayote squash, the entire squash is planted, fat end down in the ground, with

3.

the stem just level with the soil’s surface.17 SOURCES 1.

16

PennState Extension site. Dandelion and common purslane: ubiquitous edible weeds. 23 Feb 2021. https://extension.psu. edu/dandelion-and-common-purslaneubiquitous-edible-weeds. Accessed 14 Mar 2022.

4.

5.

Udain K, Juraimi AS, Hoosain S. Purslane weed (Portulaca oleracea): a prospective plant source of nutrition, omega-3 fatty acid, and antioxidant attributes. Scientific World J. 2014; 2014: 951019.

The Washington Post site. How to pick and prepare purslane. https://www. washingtonpost.com/archive/lifestyle/ food/2002/06/19/how-to-pick-andprepare-purslane/5109fc88-1282-40728539-a2321798ac2b/. Accessed 14 Mar 2022.

BBC Goodfood site. Jerusalem artichoke. https://www.bbcgoodfood.com/glossary/ jerusalem-artichoke-glossary. Accessed 14 Mar 2022.

Covington L. What are Jerusalem

Nutrition Health Review • March–April 2022 • Volume 139

15.

16.

17.

artichokes. Updated 28 Jul 2021.

The Spruce Eats site. https://www. thespruceeats.com/what-arejerusalem-artichokes-and-how-to-usethem-4783505. Accessed 14 Mar 2022.

Heal with Food site. Jerusalem Artichokes: Health Benefits & Nutritional Properties. https://www.healwithfood.org/healthbenefits/jerusalem-artichokes.php.

Accessed 14 Mar 2022.

Joybilee Farm site. How to grow sunchokes for perpetual harvest. https://joybileefarm.com/growsunchokes/#:~:text=It’s%20easy%20 to%20grow%20sunchokes,center%20 of%20your%20flower%20bed. Accessed 15 Mar 2022.

Neverman L. Before you plant sunchokes, you need to read this post. 18 Jan 2017.

Common Sense Home site. https:// commonsensehome.com/before-youplant-sunchokes/. Accessed 15 Mar 2022.

Root W. A kohlrabi by any other name.

6 Oct 1977. The Washington Post site. https://www.washingtonpost.com/ archive/lifestyle/1977/10/06/a-kohlrabiby-any-other-name/9c526db0-0a604278-ae37-37b608de04f3/. Accessed 15 Mar 2022.

Berg F. Everything to know about kohlrabi. 27 Jan 2022. Food Network site. https://www.foodnetwork.com/how-to/ packages/food-network-essentials/ kohlrabi. Accessed 15 Mar 2022.

Davidson K. Get to know kohlrabi, a versatile vegetable. Updated 2 Dec 2021.

Healthline site. https://www.healthline. com/nutrition/kohlrabi. Accessed 15 Mar 2022.

Bonnie Plants site. Growing Kohlrabi. https://bonnieplants.com/blogs/how-togrow/growing-kohlrabi. Accessed 15 Mar 2022.

Encyclopedia Britannica site. Jackfruit. https://www.britannica.com/plant/ jackfruit. Accessed 21 Mar 2022.

Guinness World Records site. Heaviest jackfruit. 23 Jun 2016. https://www. guinnessworldrecords.com/worldrecords/78709-heaviest-jackfruit.

Accessed 21 Mar 2022.

Cleveland Clinic site. What is Jackfruit and is it healthy? 11 Dec 2020. https:// health.clevelandclinic.org/what-isjackfruit-and-is-it-healthy/. Accessed 21 Mar 2022.

Hill A. 10 impressive benefits of chayote squash. 9 Apr 2019. https://www. healthline.com/nutrition/chayote-squash.

Accessed 21 Mar 2022.

Albert S. How to grow chayote. https:// harvesttotable.com/how_to_grow_ chayote/. Accessed 21 Mar 2022. NHR

Know Your Nutrient

has not provided daily, minimum, or

hydrolyzed collagen, or collagen

maximum recommendations for the

peptides, are preferable as they

ollagen, a type of protein, is a

intake of collagen itself. However,

provide collagen in a form that has

primary structural component

research suggests an intake of 2.5

been broken down already into

of the body that can be found

by Aliza Becker, BA, MPS

C

to 15 grams of functional collagen

its basic amino acids. Hydrolyzed

in the skin, tendons, bones, ligaments,

peptides per day is safe,2 and

collagen has traditionally been

cartilage, and organs. Beginning

collagen peptides may be substituted

extracted from bovine and porcine

with the discovery of Collagen II in

into the diet to meet up to 36 percent

sources, but religious and health

the 1960s, at least 28 different types

of the body’s daily protein needs

(e.g., swine flu, bovine spongiform

of collagen have been identified.1

without upsetting the balance

encephalopathy) concerns have

All types of collagen have a triple-

between nonessential and essential

facilitated increased interest in

helix structure of three intertwined

amino acids.2 Because it lacks the

marine sources as an alternative.3

polypeptides strands, known as

essential amino acid tryptophan,

Other, less common sources of

α-chains, which may vary in size

collagen is considered an incomplete

collagen, including chickens, ducks,

according to the number of amino

protein source.

frogs, and rabbits, have been

acids they contain.1 Depending on the

2

Collagen may be sourced either in

explored.3

type of collagen, these three α-chains

a direct form by consuming certain

In addition to the specific amino

may be identical to one another (e.g.,

animal products that contain it or

acids required for the collagen end-

Collagen II) or different (e.g., Collagen

indirectly by consuming foods that

product, ascorbic acid (vitamin C)

IX).1

contain the materials (i.e., amino

is a necessary cofactor for the two

acids) necessary for collagen

enzymes involved in the process

production within the body. For an

of collagen synthesis,4 which are

individual seeking to gain collagen by

prolyl hydroxylase (which stabilizes

supplementing, products containing

the collagen molecule) and lysyl

RECOMMENDATIONS FOR INTAKE The United States (US) Food and Drug Administration (FDA) to date

Nutrition Health Review • March–April 2022 • Volume 139

17

hydroxylase (which facilitates

cartilage,12 while Collagen XVI

fracture or stroke.18 A randomized,

collagen cross-linking to promote

contributes to the structural integrity

controlled trial similarly suggested

tensile strength and stability in

of the dermo-epidermal junction

that oral Collagen II supplementation

tissue). Research has suggested that

by playing a role in the interaction

may have positive effects on

the presence of adequate vitamin C

between connective tissue cells and

inflammation and degradation in

has particular benefits in Collagen I

the ECM. Finally, Collagen VI, as a

joint diseases such as osteoarthritis.19

synthesis and bone fracture healing.5

network-forming collagen, acts as a

Oral collagen supplementation may

bridge between ECM components

also increase skin elasticity, hydration,

and surrounding tissue to facilitate

and dermal collagen density.20 In a

EFFECTS IN THE HUMAN BODY Collagen loss from the body begins

13

three-dimensional organization of

pilot study, an injection of bovine

around 18 to 29 years of age, and

bone, tendon, cartilage, and skeletal

dermal collagen beneath the mucosa

the human body loses around one

muscle tissues.

in the area of the lower esophageal

percent of its collagen annually after

14

A number of hereditary diseases

sphincter led to improvements in

the age of 40 years. Other factors,

have been linked to mutations in the

10 patients with gastroesophageal

such as the presence of free radicals,

genes that provide instructions for

reflux.21 Finally, collagen has been

poor diet, smoking, alcoholism, and/

making molecules of the different

used as a wound dressing,22 bone

or chronic disease, can also increase

types of collagen. For example,

and skin graft material,23,24 and as a

this rate. The rate of collagen

mutations in COL1A1 and COL1A2

vascular closure device.25

production also continually decreases

(Type I collagen) lead to osteogenesis

with age by as much as 75 percent by

imperfecta and several types of

medications, such as tranilast (an

80 years of age.3

Ehlers–Danlos syndrome,15 while

antiallergic drug),26 glucocorticoids,27

3

3

Broadly, collagens can be

In those taking certain

those in COL4A1 (Type IV collagen)

or large doses of sustained-

subdivided into several categories

have been linked to cerebral

release methylprednisolone (a

(fibrillary, fibril-associated, and

small-vessel disease. Separately,

corticosteroid),26 collagen synthesis

network-forming) according to their

however, a number of acquired

may be impaired. Of note, however,

role(s) in the human body. Collagen

autoimmune diseases known as

tranilast inhibited collagen synthesis

I, a fibrillary collagen found in nearly

collagen vascular diseases may

in scleroderma fibroblasts to the

all connective tissues of the body,

arise in susceptible individuals.

same extent as in normal fibroblasts

plays a role in mechanical support

These conditions include those in

and keloid fibroblasts to a greater

and structural organization in the

which the body begins to attack

extent, suggesting its therapeutic

extracellular matrix (ECM);7 Collagen

its own collagen, causing tissue

potential as an antifibrotic drug.26

II is found predominantly in cartilage

weakening and breakdown, such

tissue;8 and Collagen III is a major

as systemic lupus erythematosus,

REFERENCES

structural component of hollow

polymyositis (affecting the muscles),

1.

organs, including large blood vessels,

dermatomyositis (affecting the skin),

2.

the uterus, and the bowel. During

and polyarteritis nodosa (affecting

Collagen I fibrillogenesis, Type III

the arteries), and those that result in

collagen also regulates fibril thickness

an overproduction and accumulation

in skeletal tissues,10 while Collagen

of collagen in the body, such as

V, present in most connective tissue

scleroderma.17

9

16

matrices,9 restricts fibril diameter.11 As

Extensive research on the use of

a fibril-associated collagen, Collagen

collagen for therapeutic purposes

IX is found in cartilage, where it acts

has been conducted. One study

as a macromolecular bridge between

found that oral administration of

fibrils and other ECM components

collagen peptides improved the

and is important for the “cohesive

skeletal muscle mass of patients in a

and compressive” properties of

rehabilitation ward following bone

18

Nutrition Health Review • March–April 2022 • Volume 139

3.

4.

5.

Ricard-Blum S. The collagen family. Cold Spring Harb Perspect Biol. 2011;3(1):a004978.

Paul C, Leser S, Messer S. Significant amounts of functional collagen peptides can be incorporated in the diet while maintaining indispensable amino acid balance. Nutrients.

2019;11(5):1079.

León-López A, Morales-Peñaloza A, Martínez-Juárez VM, et al. Hydrolyzed collagen—sources and applications.

Molecules. 2019;24(22):4031.

Pinnell SR. Regulation of collagen biosynthesis by ascorbic acid: a review. Yale J Biol Med. 1985;58(6):553–559.

DePhillipo NN, Aman ZS, Kennedy MI, et al. Efficacy of vitamin C supplementation on collagen synthesis and oxidative stress after musculoskeletal injuries: a systematic review. Orthop J Sports Med. 2018;6(10):2325967118804544.

6.

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Kadler KE, Holmes DF, Trotter JA, Chapman JA. collagen fibril formation.

Biochem J. 1996;316(Pt 1):1–11.

Orgel JP, Miller A, Irving RC, et al. The in situ supermolecular structure of type I collagen. Structure. 2001;9(11):1061–1069.

Bakilan F, Armagan O, Ozgen M, Tascioglu F, Bolluk O, Alatas O. Effects of native type II collagen treatment on knee osteoarthritis: a randomized controlled trial. Eurasian J Med. 2016;48(2):95–101.

Kuivaniemia H, Tromp G. Type III collagen (COL3A1): gene and protein structure, tissue distribution, and associated diseases. Gene. 2019;707: 151–171.

Wang C, Brisson BK, Terajima M, et al. Type III collagen is a key regulator of the collagen fibrillar structure and biomechanics of articular cartilage and meniscus. Matrix Biol. 2020;85-86:47–67.

Birk DE, Fitch JM, Babiarz JP, et al. Collagen fibrillogenesis in vitro: interaction of types I and V collagen regulates fibril diameter. J Cell Sci. 1990;95(Pt 4):649–657.

Olsen BR. Collagen IX. Int J Biochem Cell Biol. 1997;29(4):555–558.

Grässel S, Unsöld C, Schäcke H, et al. Collagen XVI is expressed by human dermal fibroblasts and keratinocytes and is associated with the microfibrillar apparatus in the upper papillary dermis. Matrix Biol.

1999;18(3):309–317.

Cescon M, Gattazzo F, Chen P, Bonaldo P. Collagen VI at a glance. J Cell Sci. 2015;128(19):3525–3531.

Myllyharju J, Kivirikko KI. Collagens and collagen-related diseases. Ann Med. 2001;33(1):7–21.

Lanfranconi S, Markus HS. COL4A1 mutations as a monogenic cause of cerebral small vessel disease: a systematic review. Stroke. 2010;41(8): e513–e518.

Mount Sinai. Collagen vascular disease. https://www.mountsinai.org/ health-library/diseases-conditions/collagen-vascular-disease. Accessed March 7, 2021.

Baba M, Suzaki E, Taira K, et al. [Effect of collagen peptides on skeletal muscle mass in the elderly: an interventional study examining oral nutrition support for patients in a recovery-phase rehabilitation ward].

Nihon Ronen Igakkai Zasshi. 2020;57(3):291–299.

Bakilan F, Armagan O, Ozgen M, et al. Effects of native type II collagen treatment on knee osteoarthritis: a randomized controlled trial. Eurasian J Med. 2016;48(2):95–101.

Choi FD, Sung CT, Juhasz MLW, Mesinkovsk NA. Oral collagen supplementation: a systematic review of dermatological applications. J Drugs Dermatol. 2019;18(1):9–16.

O’Connor KW, Lehma GA. Endoscopic placement of collagen at the lower esophageal sphincter to inhibit gastroesophageal reflux: a pilot study of 10 medically intractable patients. Gastrointest Endosc. 1988;34(2):106– 112.

Brett D. A review of collagen and collagen-based wound dressings.

Wounds. 2008;20(12):347–356.

Muschler GF, Negami S, Hyodo A, et al. Evaluation of collagen ceramic composite graft materials in a spinal fusion model. Clin Orthop Relat Res. 1996;(328):250–260.

Horch RE, Stark GB. Comparison of the effect of a collagen dressing and a polyurethane dressing on the healing of split thickness skin graft (STSG) donor sites. Scand J Plast Reconstr Surg Hand Surg. 1998;32(4):407–413.

Eggebrecht H, Haude M, Woertgen U. Systematic use of a collagenbased vascular closure device immediately after cardiac catheterization procedures in 1,317 consecutive patients. Catheter Cardiovasc Interv.

2002;57(4):486–495.

Yamada H, Tajima S, Nishikawa T, et al. Tranilast, a selective inhibitor of collagen synthesis in human skin fibroblasts. J Biochem. 1994;116(4):892– 897.

Cutronneo KR, Rokowski R, Counts FD. Glucocorticoids and collagen synthesis: comparison of in vivo and cell culture studies. Coll Relat Res. 1981;1(6):557–568.

Cohen IK, Diegelmann RF, Johnson ML. Effect of corticosteroids on collagen synthesis. Surgery. 1977;82(1):15–20. NHR

Healthy Activities

Planting a Medicinal Herb Garden Add Beauty to Your Outside Spaces, Attract Pollinators, and Have Access to Natural Remedies

L

ong before the post-Industrial Revolution emergence of modern (or allopathic) medicine (i.e., the practice of using drugs

or surgery, often in conjunction with counseling and lifestyle modifications, to treat health conditions), mankind relied on plants to treat ailments. While the earliest written records on the use of plants for medicinal purposes date back at least 5,000 years to the Sumerians, archeological studies have estimated that the practice of using plants as medicine date as far back as 60,000 years in Iraq and 8,000 years in China.1 Despite its long history of use,

however, herbal medicine lacks the rigorous scientific evidence that backs modern medicine practices, which can present challenges to its use among today’s healthcare practitioners and the patients they treat. That’s not to say that medicinal plants have no place or value in today’s healthcare arena. When used under supervision of a qualified healthcare provider, many plants are thought to offer therapeutic properties or beneficial pharmacological effects.2 Here, we describe several plants that may provide you with medicinal benefits while adding beauty and attracting pollinators to your garden. continued on next page Nutrition Health Review • March–April 2022 • Volume 139

19

ECHINACEA PURPUREA (PURPLE CONEFLOWER) The purple coneflower, a flowering perennial, is a member of the daisy (asteraceae) family. It produces large, showy flowers in the summer through early fall, usually purple-pink in color, that grow on tall leafy stalks that can reach 2 to 4 feet in height. Purple coneflowers aren’t fussy about where they grow: they thrive in partial shade to full sun and can tolerate moist or dry soil. Butterflies and bees love the large domed center of the coneflower, so growing echinacea is sure to make your garden a destination favorite among the pollinators.3 The flowers, leaves, and roots of the echinacea plant are thought to have antibiotic, antiviral, immuneboosting, and wound-healing properties.4

LAVENDER (LAVENDULA SPP.) Lavender is a lovely bushy perennial known for its fragrant gray-green leaves and equally fragrant, upright, blue-violet– flowered spikes. It grows 2 to 3 feet in height and width, and makes a great addition to cottage gardens. Its care is uncomplicated, provided the soil is well-drained and its location receives several hours of full sun daily. The flowered spikes can be harvested for fresh flower arrangements, and when dried, remain very fragrant, making them ideal for sachets. Bees

ALTHEA OFFICINALIS (MALLOW) The mallow plant is a bushy perennial that grows 4 to 5 feet tall. Its dramatic show of blooms from July to September will add beauty to your garden, and the small, delicate, pale pinkish flowers that cover tall, elegant spikes are loved by pollinators. The mallow plant prefers consistently moist or marshy soil, hence its more common name “marshmallow,” and it prefers at least four hours of full sunlight.5 The popular confectionary treat known as marshmallow was initially made from whipping the sap derived from the root of the mallow plant, hence the candy’s name. This practice dates back to 2000 BC with the Egyptians, who would mix the gooey root sap with nuts and honey, creating a treat so special, it was reserved for the gods and royalty. In the 1800s, the French were introduced to marshmallow when French candy makers whipped mallow root sap by hand with egg whites and sugar into a fluffy candy mold. This process was considered very timeconsuming, so the French began incorporating cornstarch to speed up the process. Eventually, the mallow root sap was replaced with gelatin, from which today’s marshmallow candy is most commonly derived.6 The mallow leaf and root have traditionally been used to treat stomach ulcers, diarrhea, and constipation.

20

7

Nutrition Health Review • March–April 2022 • Volume 139

love lavender, and hearing their hums of delight as they fly from flower to flower is nearly as relaxing as the soothing medicinal effects for which lavender is known.8 Lavender has traditionally been used to help people fall asleep.

Today, the fragrant essential oil derived from its flowers is frequently used in aromatherapy to calm nerves, soothe headaches, promote relaxation, and induce sleep. It is also thought to have some antibacterial properties.9

EDITOR’S NOTE Seek advice from a qualified healthcare

MATRICARIA RECUTITA (GERMAN

provider before using natural remedies. Always

CHAMOMILE)

inform your healthcare provider if you are

German chamomile is an

taking any medicinal herbs or using any natural remedies.

aggressively self-seeding bushy annual that grows 8 to 24 inches in

SOURCES

height and 8 to 12 inches wide, with

1. Pan S-Y, Litscher G, Gao S-H, et al. Historical perspective of traditional indigenous medical

small, aromatic, white-petaled, yellow-centered

practices: the current Renaissance and conservation of herbal resources. Evid Based Complement

blossoms that resemble daisies. It tolerates light

Alternat Med. 2014; 2014: 525340.

shade to full sun, thrives in well-drained soil, and

2. Namdeo A. Cultivation of medicinal and aromatic plants. In: Mandal SC, Mandal V, Konishi T (eds).

is considered drought-tolerant. Roman chamomile,

Natural Products and Drug Discovery: An Integrated

on the other hand, is a low-creeping perennial

Approach. Amsterdam: Elsevier; 2018:525-553.

3. Mount Sinai site. Echinacea. https://www.

often used as ground cover, with

mountsinai.org/health-library/herb/

leaves and flowers similar to the

echinacea#:~:text=Today%2C%20people%20 use%20echinacea%20to,help%20the%20body%20

German variety. Chamomile does

fight%20infections. Accessed 28 Mar 2022.

4. Senica M, Mlinsek G, Veberic R, Mikulic-Petkovsek M.

well in containers, though German

Which plant part of purple coneflower (Echinacea

chamomile requires a container large

purpurea (L.) Moench) should be used for tea and which for tincture? J Med Food. 2019;22(1):102-108.

enough to accommodate its sprawl;

5. Aloi P. How to grow marshmallow plants. 24 May

Roman chamomile stays a bit more

2021. The Spruce site. https://www.thespruce.com/ growing-marshmallow-plants-5082977. Accessed 28

contained. Either type of chamomile will add

Mar 2022.

subtle beauty to the garden, especially when used

6. National Confectioners Association site.

Marshmallows: the history of marshmallows. https://

as a ground cover (Roman) or among rocky areas or

candyusa.com/marshmallows/. Accessed 30 Mar

rock walls (German).10,11

2022.

7. WebMD site. Mashmallow: uses, side effects,

The flowers of both German and Roman

and more. https://www.webmd.com/vitamins/ai/ ingredientmono-774/marshmallow. Accessed 28

chamomile have been used as an herbal remedy

Mar 2022.

for upset stomach, muscle spasms, mild infections,

8. Iannotti M. How to grow and care for lavender. 20 Dec 2021. The Spruce site. https://www.thespruce.

and as a sleep aid; however, the German variety is

com/growing-lavender-1402779. Accessed 28 Mar

considered more potent.12,13

2022.

9. Mount Sinai site. Lavender. https://www. mountsinai.org/health-library/herb/lavender#: ~:text=Aromatherapists%20use%20lavender%20

MONARDA DIDYMA (SCARLET BEEBALM) Scarlet beebalm is a member of the mint family.

Beebalm’s common name refers to a resin that can be extracted from the plant that can soothe bee stings.

Beebalm is a perennial native to North America and grows up to 3 feet in height. It has vivid dark pink- to scarlet-colored blossoms that erupt from domed flower heads, making it a striking addition to the garden and a favorite among butterflies and hummingbirds. Beebalm grows in partial to full sun and moist, fertile soil. It is a vigorous self-seeder and requires little care.14

in%20inhalation,for%20joint%20and%20muscle%20 pain. Accessed 28 Mar 2022.

10. Rhoades H. Tips for how to grow chamomile.

Gardening Know How site. https://www. gardeningknowhow.com/edible/herbs/chamomile/ growing-chamomile.htm. Accessed 29 Mar 2022.

11. Iannotti M. How to care for and grow chamomile.

The Spruce site. https://www.thespruce.com/ how-to-grow-chamomile-1402627. Accessed 29 Mar 2022.

12. Mount Sinai site. German chamomile. https:// www.mountsinai.org/health-library/herb/germanchamomile#:~:text=Animal%20studies%20have%20 shown%20that,bacteria%2C%20fungus%2C%20 and%20viruses. Accessed 29 Mar 2022.

13. Srivastava JK, Shankar E, Gupta S. Chamomile: a herbal medicine of the past with bright future. Mol Med Report. 2010 Nov 1; 3(6): 895–901.

14. United States Forest Service site. Plant of the week:

Beebalm has traditionally been used as an anti-inflammatory, antispasmodic, and decongestant. It is thought to have antimicrobial and analgesic properties. Beebalm has also been used traditionally to relieve nausea and

scarlet beebalm (Monarda didyma L.). https://www. fs.fed.us/wildflowers/plant-of-the-week/monarda_ didyma.shtml. Accessed 29 Mar 2022.

15. Chauhan M. What are the medicinal properties of beebalm (monarda)? 5 Aug 2019. Planet Ayurveda site. https://www.planetayurveda.com/library/ bee-balm-monarda/. Accessed 30 Mar 2022. NHR

indigestion.15 Nutrition Health Review • March–April 2022 • Volume 139

21

Mental Wellness

Nutrition for

Stress and Anxiety

S

tress and anxiety are two

negative impact on overall

B group vitamin supplementation

separate emotional states,

health, if left unchecked.

had on mood in healthy and “at-

though they share similar

While it is important to note

risk” populations. Eighteen studies,

1

symptomology. Stress is triggered

that chronic stress and more severe

with a total of 2,015 participants,

by environmental factors that may

forms of anxiety will likely require

were included, of which 12 studies

be short-term (e.g., a work or school

therapeutic interventions, such as

were eligible for meta-analysis.

deadline, an unexpected financial

psychotherapy and/or medication,

The researchers reported that 11 of

hardship, a fight with a friend or

from a licensed healthcare provider,

the 18 studies indicated B vitamin

loved one) or long-term (e.g., being

all levels of stress and anxiety may

supplementation had a positive

unable to find work, caring for a

benefit from lifestyle modifications,

effect over placebo on overall

chronically ill loved one, extended

including diet, exercise, and good

mood or some facet of mood. Of

financial problems). Anxiety, on

sleep hygiene. In this article, we

the eight studies that included “at-

the other hand, is defined by the

review some key nutrients that have

risk” participants (i.e., participants

American Psychological Association

demonstrated positive effects on

with nutritional deficiency, elevated

as “persistent, excessive worries that

stress and/or anxiety.

scores on a psychological mood

don’t go away even in the absence of a stressor.” Symptoms of both stress and anxiety include insomnia,

assessment scale, symptoms of a B VITAMINS In a systematic review and meta-

mood disorder considered below diagnostic threshold, or vulnerability

difficulty concentrating, fatigue,

analysis by Young et al,2 investigators

to mood disorders), five studies

muscle tension, and irritability, and

evaluated randomized, controlled

reported B vitamin supplementation

both emotional states can have a

trials (RCTs) that assessed the effect

was beneficial to mood—specifically,

22

Nutrition Health Review • March–April 2022 • Volume 139

B vitamin supplementation was

common form of magnesium used in

heart rates were measured before

significantly beneficial to stress, but

the studies, followed by magnesium

the start of the study and one day

the benefit to depression did not

oxide. Seven studies combined

after the study (Day 15). Baseline

reach significance and no effect

magnesium with vitamin B6, and two

and post-intervention anxiety levels

on anxiety was observed. The

studies combined magnesium with

were measured using the Beck

authors of the systematic review

extract of hawthorn. Eight studies

Anxiety Inventory (BDI). According to

and meta-analysis concluded that

recruited participants reporting mild-

the authors, students in the vitamin

B vitamin supplementation has

to-moderate subjective anxiety, seven

C treatment group had reduced

beneficial effects on overall mood

studies recruited women reporting

anxiety levels, as measured by

and symptoms of stress—particularly

mild-to-moderate PMS symptoms,

BDI, and higher plasma vitamin C

in those who have poor nutritional

one study evaluated the effects of

concentration compared to those

status or are considered vulnerable to

magnesium on postpartum anxiety,

administered the placebo. The

mood disorders—but did not appear

and two studies recruited participants

authors also reported that mean

to benefit depression or anxiety.2

with mild hypertension. Four out

heart rates were significantly different

B vitamins include thiamin

of eight studies in anxiety, four out

between vitamin C group and placebo

(B1), riboflavin (B2), niacin (B3),

of seven studies in PMS, and one

control group, though they didn’t

pantothenic acid (B5), pyridoxine (B6),

out of two studies in hypertension

specify exactly what they meant by

biotin (B7), folate/folic acid (B9), and

samples reported positive effects

“significantly different.” The authors

pyanocobalamin (B12). B vitamins in

of magnesium on subjective anxiety

did not observe a difference in blood

food are easily destroyed by alcohol,

outcomes. Investigators reported

pressure between the two groups.

cooking, or processing. Natural

that magnesium had no effect on

The authors concluded that vitamin C

sources of B vitamins include whole

postpartum anxiety. None of the

and antioxidants may play important

grains, eggs, legumes, citrus fruits,

studies included in the systematic

therapeutic roles in the prevention

avocados, meat/fish/poultry, and liver.

review administered a validated

and treatment of anxiety, but larger

Fortified breakfast cereals are also

measure of subjective stress as an

controlled clinical studies are needed

good sources of B vitamins.3

outcome. The investigators concluded

to support these findings.6

that available evidence suggests MAGNESIUM In a systematic review, researchers

Natural sources of vitamin C

magnesium has a beneficial effect

include citrus fruits, such as orange,

on subjective anxiety in vulnerable

kiwi, lemon, grapefruit; bell peppers;

examined the available evidence

participants; however, they noted

strawberries; tomatoes; cruciferous

for the efficacy of magnesium

that the quality of available evidence

vegetables, such as broccoli, Brussel

supplementation in the treatment of

is poor and that better-designed,

sprouts, cabbage, and cauliflower;

subjective symptoms of anxiety and

controlled trials are needed to support

and white potatoes.7

stress.4 The investigators included

these findings.4

studies evaluating magnesium

Natural sources of magnesium

ZINC

alone or in combination with other

include leafy greens, nuts, seeds, dry

ingredients. Eighteen studies

beans, whole grains, wheat germ, and

Russo,8 researchers sought to

met the inclusion criteria, 10 of

wheat and oat bran.5

test the hypothesis that there is a relationship between copper and

which recruited male and female participants. Eight studies recruited

In a preliminary study by

zinc concentration and improvements

VITAMIN C

female participants only—seven that

In a small RCT by de Oliveira,

examined the effects of magnesium

investigators examined the effects

anxiety, as measured by the Hamilton

on premenstrual syndrome (PMS)

of oral vitamin C supplements on

Rating Scale for Anxiety (Ham-A)

and one that examined the effects of

anxiety in 42 adult students. The

and 16 age-, sex-, and size-matched

magnesium in postpartum anxiety,.

students were administered either

healthy controls were recruited to

Magnesium doses across all studies

500mg of vitamin C a day or placebo

participate in this study. Serum zinc,

ranged from 46.4 to 600mg, and

for 14 days. Plasma concentrations

copper, copper-zinc couple, and

magnesium lactate was the most

of vitamin C, blood pressure, and

antioxidant levels were collected at

in anxiety. Thirty-two adults with

Nutrition Health Review • March–April 2022 • Volume 139

23

baseline and at the end of the study

2.

BOTTOM LINE

from all participants. Individuals with

Young LM, Pipingas A, White DJ, et al. A systematic review and meta-analysis of B vitamin

For mild symptoms of stress, a diet

supplementation on depressive symptoms, anxiety, and stress: effects on healthy and ‘at-risk’

anxiety had significantly higher plasma

comprising a wide variety of whole

levels of copper and lower plasma

foods and lean meats, along with

levels of zinc compared to controls.

regular exercise and a good sleep

Twenty of the 38 patients with anxiety

routine, bolsters your body with the

(chosen randomly) were given zinc and

nutrients it needs to combat the

vitamin B6 therapy for eight weeks.

negative effects stress can have on

Post-therapy, zinc levels normalized

your health. Mild anxiety can benefit

(increased to the normal range) and

from these lifestyle modifications as

org/health/articles/15650-magnesium-rich-

copper-zinc couple levels significantly

well. However, for chronic stress or

food#:~:text=In%20general%20rich%20sources%20

decreased after zinc and B-6 therapy,

more severe symptoms of anxiety,

but copper did not significantly

seeking the help of a licensed

decrease. Symptoms of anxiety (a

healthcare professional, in addition

scale of 1 to 5; 5 being the most

to lifestyle modifications, may be

symptomatic) of these same patients

necessary. Consult with your physician

improved significantly post-therapy.

or a qualified dietitian/nutritionists to

The study investigators concluded that

learn which, if any, supplements may

zinc therapy is effective in increasing

be beneficial to your health.

individuals. Nutrients. 2019;11:22–3.

3.

Nourish by WebMD site. Foods high in B vitamins.

Last reviewed 13 Dec 2020. https://www.webmd. com/diet/foods-high-in-b-vitamins#2

4.

Boyle NB, Lawton C, Dye L. The effects of magnesium supplementation on subjective anxiety and stress—a systematic review. Nutrients. 2017;9: 429.

5.

Cleveland Clinic site. Magnesium-rich foods. Last reviewed 24 Nov 2020. https://my.clevelandclinic.

of,310%2D320%20mg%20per%20day. Accessed 14 Mar 2020.

6.

de Oliveira I, de Souza V, Motta V, Da-Silva S. Effects of oral vitamin C supplementation on anxiety in students: a double-blind, randomized, placebocontrolled trial. Pakistan J Biologic Sci. 2015;18(1): 11–18.

7.

Harvard TH Chan School of Public Health site. The nutrition source: vitamin C. Updated Mar 2020. https://www.hsph.harvard.edu/nutritionsource/ vitamin-c/. Accessed 14 Mar 2022.

8.

zinc plasma levels and that zinc

Russo AJ. Decreased zinc and increased copper in individuals with anxiety. Nutrition Metabolic Insights.

supplementation may play a role in

SOURCES

improving symptoms of anxiety.8

1.

Natural sources of zinc include meat, shellfish, legumes, seeds, and nuts.9

2011;4:1–5

American Psychological Association. What’s the difference between stress and anxiety? Last updated 14 Feb 2022. https://www.apa.org/topics/ stress/anxiety-difference. Accessed 14 Mar 2022.

9.

West H. The 10 best foods that are high in zinc. 19 Apr 2018. Healthline site. https://www.healthline. com/nutrition/best-foods-high-in-zinc. Accessed 14 Mar 2022. NHR

Healthy Activities

The Need to Personalize the APPROACH TO NUTRITION

by Aliza Becker, BA, MPS

A

preponderance of fast food options.1 They are more

variety of factors are known to influence our

often found in low-income and rural areas and provide

individual nutrition choices. As such, malnutrition

residents with inadequate or poor food choices.2 Living

may develop in response to external influencers

in a food desert census district compared to a non–food

in the surrounding environment, demographics, lifestyle

desert census district in the United States (US) can

choices, and congenital conditions alike.

increase the odds of obesity by 30 percent.3 Meanwhile,

Originating as a concept in Scotland in the 1990s,

food insecurity, defined by the US Department of

a “food desert” is a geographic area with insufficient

Agriculture as a “reduced quality, variety, or desirability

access to affordable and nutritious food, often

of diet” or “multiple indications of disrupted eating

due to the combined lack of supermarkets and a

patterns and reduced food intake”2 (which may occur

24

Nutrition Health Review • March–April 2022 • Volume 139

among those living in food deserts),

diets than men, and Hispanics had

ultimately to consider individuals’

is associated with stunted growth

better-quality diets than either

genetic, phenotypic, medical,

among children in lower-middle–

blacks or whites.10 In the context of

nutritional, and other relevant

and upper-middle–income countries

employment, shift workers may be

information to design unique

(but overweightness among girls in

at greatest risk for an unhealthy

plans for healthy eating, disease

middle- and high-income countries),

diet, including greater consumption

avoidance, and well-being.17

low birth weight in infants, and

of saturated fats and soft drinks,11

anemia in women.

while people who are either self-

4

Of note, individuals experiencing

employed, civil servants, have

food insecurity may be ultimately at

a permanent contract, or are a

greater risk for the development of

noncontracted worker and those

hypertension, diabetes, and other

who are physically active during

chronic conditions due to their

their main job tend to have a higher

nutrition-poor diet. International

quality of diet.12 In children, parents

variations in the differences in

influence food preferences and

cost of a calorie between healthy

eating behaviors by making some

and unhealthy foods also serve

foods available to their children

to exacerbate nutrition-related

over others and by acting as models

health issues on a global scale.6 For

of eating behavior, which can have

example, calories from eggs are 23.3

lifelong implications.13

5

times more expensive than those

Hereditary conditions can

from staple foods such as rice,

necessitate the avoidance of

bread, and corn in Niger, but only

certain foods, leading to nutritional

1.6 times as expensive in the United

deficiencies.Ffor example,

States.7

people with celiac disease on an

A variety of demographic and

established gluten-free diet may

lifestyle-related factors may

have insufficient intake of iron,

affect nutrition. One Spanish

zinc, and vitamins D and B6,14 while

study reported that less-educated

those with irritable bowel syndrome

individuals; those who are current

may have a zinc deficiency due to

smokers; those who are less

avoiding milk as a trigger food.15

physically active; and those who

As such, it is clear that there is

are single, divorced, or separated

no one-size-fits-all approach to

are less likely to adhere to a

eating for everyone. In response, the

Mediterranean dietary pattern,

concept of personalized nutrition

considered by the study authors

first emerged in the 1940s before

to be an ideal model for food

gaining steam in 2003,16 and

choices. In Portugal, researchers

interest has only grown since then,

found that smokers also had a

especially as new findings in the

higher intake of alcoholic beverages

fields of genetics and food analytics

and a lower consumption of food

have been made.17 Today, beyond

items rich in fiber, antioxidants, and

tailoring nutrition plans to the

phytochemicals.9

needs of special populations, such

8

Among Americans, children and

as pregnant or lactating women,

older adults had better-quality diets

athletes, or people with certain

than younger and middle-aged

chronic or hereditary diseases, the

adults, women had better-quality

field of personalized nutrition seeks

SOURCES 1.

Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966– 2007. Prev Chronic Dis. 2009;6(3):A105.

2. Dutko P, Ver Ploeg M, Farrigan T. Characteristics and influential factors of food deserts. https://www.ers.usda.gov/ webdocs/publications/45014/30940_ err140.pdf. Accessed March 17, 2022.

3. Chen D, Jaenicke EC, Volpe RJ. Food environments and obesity: household diet expenditure versus food deserts. Am J Public Health. 2016;106(5):881–888.

4. Maitra C. A review of studies examining the link between food insecurity and malnutrition. https://www.fao.org/3/ CA1447EN/ca1447en.pdf. Accessed March 17, 2022.

5. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–310.

6. Headey DD, Alderman HH. The relative caloric prices of healthy and unhealthy foods differ systematically across income levels and continents. J Nutr.

2019;149(11):2020–2033.

7. Headey DD, Alderman HH. Why living in a poor country means you have bad food choices. https://theconversation.com/whyliving-in-a-poor-country-means-you-havebad-food-choices-121993. Accessed March 17, 2022.

8. Hu EA, Toledo E, Diez-Espino J, et al.

Lifestyles and risk factors associated with adherence to the Mediterranean diet: a baseline assessment of the PREDIMED trial. PLoS One. 2013;8(4):e60166.

9. Padrão P, Lunet N, Santos AC, Barros H. Smoking, alcohol, and dietary choices: evidence from the Portuguese National Health Survey. BMC Public Health.

2007;7:138.

10. Hiza HAB, Casavale KO, Guenther PM, Davis CA. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet.

2013;113(2):297–306.

11. Souza RV, Sarmento RA, de Almeida JC, Canuto R. The effect of shift work on eating habits: a systematic review. Scand J Work Environ Health. 2019;45(1):7–21.

12. de la Cruz SP, Cebrino J. Trends in diet quality and related sociodemographic, health, and occupational characteristics among workers in Spain: results from

Nutrition Health Review • March–April 2022 • Volume 139

25

three consecutive National Health Surveys (2006–2017). Nutrients. 2021;13(2):522.

13. Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics.

2007;35(1):22–34.

14. Kreutz JM, Adriaanse MPM, van der Ploeg EMC, Vreugdenhil ACE. Narrative review: nutrient deficiencies in adults and children with treated and untreated celiac disease.

Nutrients. 2020;12(2):500.

15. Hujoel IA. Nutritional status in irritable

bowel syndrome: a North American population-based study. JGH Open.

2020;4(4):656–662.

16. Bland JS. The evolution of personalized nutrition—from Addis, Pauling, and RJ Williams to the future. Integr Med (Encinitas). 2019;18(6):10–13.

17. Chaudhary N, Kumar V, Sangwan P, et al. Personalized nutrition and -omics. In: Cifuentes A. Comprehensive Foodomics.

Amsterdam, Netherlands: Elsevier; 2021: 495–507.

ABOUT THE AUTHOR Ms. Becker is the managing editor of The Journal of Innovations in Cardiac Rhythm Management. She also works as a freelance editor and as a teaching assistant for the George Washington University’s Master of Professional Studies in Publishing program. NHR

Healthy Activities

Temperance Training Fitness with a Purpose

Temperance Training is nonprofit inclusive community of men and women who are recovering from alcohol or drug addiction and who value spiritual and physical fitness. Their mission is to inspire health and hope and to destigmatize the disease of addiction in our society. Here, the NHR staff talks with cofounder and head coach of Temperance Training, Anthony Fazio, who tells us about the foundation and its annual Outwork Addiction fundraising event.

HOW DID TEMPERANCE TRAINING

mentally and physically. We wanted

fellowship. In 2019, Tim and his wife

BEGIN?

to offer free CrossFit classes, group

Gia (who ran the show from behind

ANTHONY: Temperance Training

meditations, and other sober

the scenes) moved to Colorado to

is a nonprofit organization that

festivities to anyone in recovery. Our

grow their family, so my wife, Marci,

Tim Mustion, Rob Plamondon,

friend, Rob, the owner of CrossFit

stepped into the role of creative

and I founded in 2007 in Boca

Hype in Boca Raton got on board

coordinator at that time.

Raton, Florida. Tim and I are

and let Tim and me run classes from

both in recovery and found that

his gym and use his equipment. We

WHAT ARE THE WEEKDAY

fitness, specifically CrossFit, helps

strive to foster personal growth

WARRIOR AND SOBER SUNDAY

strengthen our sobriety, put us in

through physical endurance,

CLASSES?

touch with other health-minded

peer to peer accountability, and

humans, and make us stronger

opportunities for service and

26

Nutrition Health Review • March–April 2022 • Volume 139

ANTHONY: Weekday Warriors is just our name for the free classes

we offer to men and women in

PLEASE SHARE MORE ABOUT

recover. The classes are held at

YOUR ANNUAL FUNDRAISER,

1pm every Monday through Friday

THE OUTWORK ADDICTION

at our Boca Raton location. Sober

COMPETITION.

Sunday is held every Sunday at 9am.

ANTHONY: Outwork Addiction

The Weekday Warriers and Sober

is the annual fundraiser we started

Sunday classes follow the same

in 2018. It’s our main source of

fitness programming as CrossFit

donations, and provides the funding

Hype, in that each class is an hour

for most everything Temperance

long and includes a warm-up that

Training does. Individuals in our

is typically followed by a strength

community use an amazing platform

component and a metabolic

called “Give Lively,” which provides

conditioning (MetCon) piece. The

fundraisers all the tools they need

classes are coached by our certified

to share Temperance Training’s story

Temperancce Training coaches.

and their own if they want to.

There are usually anywhere from 5

The culmination of the fundraiser

to 30 people in each class, and on

is the CrossFit competition in

Sober Sundays, we have welcomed

November. To encourage competitors

as many as 100 participants to a

to fundraise, we keep the registration

class.

fee minimal and set a “suggested fundraising goal” for each athlete.

DO PARTICIPANTS FORM BONDS

The top fundraising team wins prizes

AND ESTABLISH RELATIONSHIPS

sure to be coveted by any fitness

THROUGH TEMPERANCE

enthusiast. For the competition,

TRAINING?

there are four divisions: Men’s Scaled

Each November, Temperance Training hosts a CrossFit competition— Outwork Addiction—which provides athletes of all levels the opportunity to compete for prizes while raising money for the organization.

ANTHONY: Yes! The bonds our athletes establish with one another are unique, not only because we encourage the camaraderie and connection formed in any CrossFit class, but because most of us have experienced the same hardships and triumphs that only people in recovery know.

DO PARTICIPANTS NEED BE IN TOP PHYSICAL SHAPE TO JOIN A TEMPERANCE TRAINING CLASS? ANTHONY: Because every movement is scalable, absolutely anyone of any fitness level can take one of our classes. All we ask is that participants have at least 24

Participants in the annual Outwork Addiction competition are encouraged

hours of sobriety. Loved ones are

to raise money for Temperance Training. Teams who raise the most money

also encouraged to join us, as many

are awarded prizes. The money raised during the event funds Temperance

have been equally affected by the

Training’s free CrossFit classes and other healthy lifestyle events they host

disease of addiction.

throughout the year.

Nutrition Health Review • March–April 2022 • Volume 139

27

Addiction total. The glue that holds

temperancetraining.org or by

the event together, however, really

volunteering their time during

are the volunteers. Without them,

our CrossFit event in November.

we would not be able to run this

They can also donate goods and

amazing day.

services to our raffle or as prizes

Funds raised through Outwork

The annual Outwork Addiction fundraising event holds a raffle that is jam-packed with impressive items donated by local vendors.

Volunteer registration and other

Temperance Training classes free

donation information will be posted

throughout the year. Coaches

via social media—Facebook:

who have earned a CrossFit Level

Temperance Training; Instagram: @

1 Trainer scholarship work as

temperancetraining—as well as on

volunteers for a set period of time,

our website, temperancetraining.org,

and then they are paid for the

closer to the time of the event.

(beginner), Men’s RX (advanced),

classes they coach. We also pay

Women’s Scaled (beginner), and

our staff to coordinate scheduling,

Women’s RX (advanced). There

run payroll, organize events, and

are typically three workouts to be

advertise and post on social media,

completed on a strict schedule of

among other things. Part of the

heats throughout the day.

funds we raise goes back into the

Vendors can pay to set up tents or

for the competition winners.

Addiction literally keep our

NHR

gym, CrossFit Hype, to upgrade

tables to give away samples and/

equipment and pay for time and

or flyers with information about

space. Eventually, we hope to fund

their products and services, and

Temperance Training community

some vendors sell their goods at

outings, such as movie or bowling

discounted rates for our athletes

nights, as well as additional

and spectators. Food and drinks

scholarships for CrossFit L1 Trainer

are included and are available to

Certificates and other needs of the

spectators, judges, and athletes.

community.

Prizes are given to 1st, 2nd and 3rd place winners in all four divisions,

HOW CAN READERS OF NHR GET

and each registered athlete receives

INVOLVED TO SUPPORT OUTWORK

a goodie bag, as well. There is a

ADDICTION EVENTS?

raffle that is always jam-packed

ANTHONY: Readers can

with fun, interesting, luxurious, and

help keep Temperance Training

adventure-filled items, helping raise

classes free and our community

even more funds toward our Outwork

thriving by donating funds via

“The glue that holds the annual Outwork Addiction fundraising event together are the volunteers.

Without them, we would not be able to run this amazing day.”

FAST FACT— As a little as two years of consistent aerobic exercise 4 to 5 days a week can have a dramaticly positive effect on the health of a previously sedentary middleaged person’s heart.

SOURCE: Shibata S, Fujimoto N, Hastings JL, et al. The effect of lifelong exercise frequency on arterial stiffness. J Physiol. First published: 20 May 2018 https://doi.org/10.1113/JP275301.

28

Nutrition Health Review • March–April 2022 • Volume 139

Superfood Spotlight

Garlic G

arlic has been a staple in the

components that contribute to its

prevent atherosclerosis—a condition

human diet and in medicine

pharmacological properties. One of

caused when there is a build-up

for thousands of years.1-3

its sulfur-based compounds, allicin,

of fats, cholesterol, and other

Some might even call it the food of

gives garlic its savory flavor and

substances in and on the artery walls

legends, one of that supposedly

pungent smell. Allicin is also what

.8-10 Similarly, garlic has also been

protects against everything from

makes garlic a healthy addition to

shown to help lower cholesterol,

common colds to heart disease.1-4

your diet. Here are some reasons

blood pressure, and blood sugar.1,4,10

Garlic was traditionally used for

this herb ranks highly as a health-

However, these changes are typically

health purposes by people all over

protecting food.

observed when people consume

the world, including the Egyptians,

high supplemental doses of garlic,

Greeks, Romans, Chinese, and

STRONG ANTIOXIDANT CAPACITY

particularly in powder or tablet

Japanese. During the Middle Ages,

FOR METABOLIC HEALTH

forms, so you may not gain the

garlic was reputed to have been

Many of garlic’s health benefits,

same health benefits by adding

highly effective against the plague.

especially as they relate to

a couple of cloves to a recipe.4 It

While many of the traditional

heart health, are grounded in

may take more than eight weeks

medicinal uses of herbs and plants

its antioxidant properties.

before noting any improvement.1

have yet to be supported by vigorous

Antioxidants fight free radicals—

Research about this herb’s effect on

randomized, controlled studies, the

unstable molecules your body

metabolic and heart disease can

nutritional and medicinal value of

naturally forms when it converts

also be inconsistent. Experts say this

garlic has stood the test of time.

food into energy—that cause

may be due to the large variation in

Even today, garlic is commonly

oxidative stress, which can damage

garlic products—including powders,

promoted as a dietary supplement

cells. Oxidative stress plays a role

as a fresh or raw plant, oils, and

for certain health conditions.1

in a variety of diseases, increases

more—which make it difficult to

Garlic is versatile. In fact, its three

inflammation in the body, and can

determine the true effect of garlic

in one! Garlic is a vegetable because

accelerate age-related processes.8

on cardiovascular morbidity and

5

it is an edible plant. It’s also an

4-6

7

Garlic consumption in particular

mortality.6

herb, which is defined as any plant

has been shown to mitigate

used as medicine, seasoning, or

multiple risk factors associated with

flavoring.1 Finally, it’s a spice, which

heart diseases. For example, the

is a dried plant-derived substance

antioxidant properties of aged garlic

have antibacterial and antifungal

used to flavor food.4 On top of being

extract has been shown to reduce

properties.11 This herb has been

a relatively nutrient-dense food,

inflammation, particularly in the

used throughout history to treat

garlic contains biologically active

vessels of the heart. This may help

various diseases and wounds before

ANTIMICROBIAL PROPERTIES Garlic extract has been shown to

Nutrition Health Review • March–April 2022 • Volume 139

29

antibiotics were widely available.

inflammatory processes that

side effects include breath and body

Now that antibiotic-resistance

characterizes many chronic and

odor, heartburn, and upset stomach.

against microorganisms has

acute condtions.7,11,15,21 When the

become such a serious issue, some

body encounters an offending

researchers are again turning toward

agent, such as viruses, bacteria, or

garlic’s antimicrobial activities

toxic chemicals, it activates your

of garlic depend on the way it is

because of its inhibitory effects

immune system.22 Once those alarms

prepared, so taking advantage

against pathogenic viruses, bacteria,

bells go off, your body sends out

of its health benefits can become

and fungi.12-15

inflammatory cells and cytokines—

complicated. While garlic is usually

While garlic is not as potent as

PREPARATION The pharmacologic properties

substances that stimulate more

cooked and added for extra flavor,

modern antibiotics, it may help the

inflammatory cells—to combat the

it can also be eaten raw.1,15,16 Raw

body resist or destroy viruses and

offending agents. While inflammation

garlic may better retain allicin, which

other microorganisms, such as staph,

is a natural biological response,

is responsible for many of its health

E. coli, and Salmonella. A 2020 study

chronic inflammation, which

benefits. Some studies show that

showed that garlic extracts could

occurs when your body continues

roasting, boiling, heating, or pickling

be therapeutic in treating bacterial-

dispatching these cells even when

garlic can significantly reduce its

mediated urinary tract infections.16

there is no danger, can damage

allicin content.27,28

Components of garlic have also

healthy tissues and organs. Garlic

been shown to have to inhibit

has been shown to exert potent anti-

popular. These can come in the forms

viral cell growth in warts. In one

inflammatory effects by decreasing

of powders, oils, extracts tablets,

placebo-controlled trial, the topical

the inflammatory biomarkers,

capsules, or topical preparations.2,15

application of garlic chloroform

including those found in people with

Research shows that aged garlic

extract—a type of liquid extraction—

renal disease and certain cancers.2,14,24

extract (AGE), which undergoes a

resulted in the complete resolution of

Garlic supplementation can also

20-month ageing and extracting

cutaneous warts with no recurrence

boost microbial richness and diversity,

process, is richer in antioxidants than

which can counteract inflammation

fresh garlic or other preparations.6,15

garlic may help treat athlete’s foot,

from obesity, hypertension, diabetes,

This means that AGE may be an

a type of recurring fungal infection

and inflammatory bowel disease.

optimal choice for those looking to

characterized by a scaly, itching, and

Garlic oil has been used to treat

maximize the nutritional benefits of

stinging rash. A small, randomized,

sore and inflamed joints or muscles;

garlic. It is worth noting that not all

controlled trial showed that topical

the Arthritis Foundation even

garlic supplements are standardized,

application of ajoene—a derivative

recommends it to help prevent

and even standardized brands’

of garlic—resulted in complete cure

cartilage damage from arthritis.26

bioavailability of allicin and other

5

after three to four months.

17,18

Finally,

19

23

25

in 79 percent of participants after seven days.20 Always consult a physician before therapeutic garlic

Garlic supplements are also very

important nutrients will vary.2,11 POTENTIAL RISKS While garlic is safe and well

BOTTOM LINE Garlic has been used for

consumption. Its health benefits can

tolerated in most peoples’ diets,

take weeks to show any significant

there is a small risk that eating

medicinal and nutritional purposes

effect and topical application of

large quantities of it (i.e., more than

for thousands of years, and a

garlic exacts can cause itching,

four cloves a day) can affect the

recent increase in the popularity of

redness, and swelling in some

blood’s ability to clot.1,15,18 Given this,

alternative medicine and natural

people.

people should be wary of consuming

products has renewed interest this in

garlic before and after surgery

herb and its derivatives as potential

and not to exceed this amount if

natural remedies.2 Garlic’s culinary

taking anticoagulant medications.1

versatility is closely matched by its

inflammatory properties, making

Similarly, garlic may interfere with the

various health benefits, including

it an important tool for preventing

effectiveness of some drugs. Other

its high antioxidant capacity,

PREVENTS INFLAMMATION Garlic has potent anti-

30

Nutrition Health Review • March–April 2022 • Volume 139

antimicrobial assets, and antiinflammatory properties. More research is needed to further define and confirm this herb’s health

9.

10.

benefits, but current studies have demonstrated some therapeutic potential.2 Still, you should always

11.

contact your doctor before consuming garlic or its related products for health purposes.

12.

SOURCES

1.

2.

3.

4.

5.

6.

7.

8.

Weil A. Garlic. National Geographic Guide to Medicinal Herbs: The World’s Most Effective Healing Plants.

Washington, DC: National Geographic Partners;2010:152-157.

Bayan L, Koulivand PH, Gorji A. Garlic: a review of potential therapeutic effects.

Avicenna J Phytomed. 2014;4(1):1-14.

NCCIH. Updated Dec 2020. Garlic.

National Center for Complementary and Integrative Health website. https://www. nccih.nih.gov/health/garlic. Accessed 28 Mar 2022.

Merschel M. 19 Apr 2021. Sorting folklore from fact on the health benefits of garlic. American Heart Association website. https://www.heart.org/en/ news/2021/04/19/sorting-folklore-fromfact-on-the-health-benefits-of-garlic.

Accessed 1 Apr 2022.

Longe LL. Garlic. The Gale Encyclopedia of Alternative Medicine, 5th Edition.

Farmington Hills, MI: Gale; 2020: 10971102.

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RESEARCH BITES Research shows healthy home cooking equals a healthy mind. New research has found being confident in the kitchen is not only good for your taste buds: it’s also good for your mental health. Read more: https://www. sciencedaily.com/releases/2022/03/220321091919.htm Large study challenges the theory that light alcohol consumption benefits heart health. In an observational analysis of UK Biobank participants, light to moderate drinkers had the lowest heart disease risk, followed

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by people who abstained from drinking; however, light to moderate drinkers tended to have healthier lifestyles than abstainers, which likely accounted for their better heart health. Genetic evidence in this same population suggested that all levels of alcohol intake are associated with increased cardiovascular risk. Notably, the risk of cardiovascular disease linked to light alcohol consumption was modest but rose exponentially with higher intake, even at intake levels currently endorsed as ‘low risk.’ Read more: https://www.sciencedaily.com/ releases/2022/03/220325122708.htm Nutrition Health Review • March–April 2022 • Volume 139

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